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� IVEQQ <br /> D E RECEIVED EHD LOG NUMBER <br /> W';9 SAN JOAQUIN COUNTY <br /> JUN 3 0 20W ilk ENVIRONMENTAL HEALTH DEPARTMENT <br /> nRa4ME.WAL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PErt�r1ITISERNnCEV lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC <br /> �^RECORDS RELEASE APPLICATION <br /> APPLICANT:_ EI t Zy, <br /> a -Pb4 U CA kd-Zh ) BUSINESS/AGENCY: Ae ( COY1S u-UZt.V1 tr <br /> ADDRESS: _SZO 3"' ,Sh�Q� &u to 2 C( CITY/STATE/ZIP: 00*-t CA gL-J(lD� <br /> PHONE(1): SI D - g07-3)LjSXZl6q PHONE(2):90-&$1-75I q FACSIMILE:510 -538 —3 <br /> Please allow 10 business days from,date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE b(Ql3011 (a <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> Street# Street Name CityEHD <br /> 1. 1 ti-01I lNorffi FIa Ci4 FouLl2var01, L_&Ai 5rf 3 <br /> z. e1r k, <br /> �-� ❑Unit 1 <br /> 3. <br /> 4. r4-4 i4 [v} i2 <br /> ❑Unit PH ` <br /> 5. <br /> 6. <br /> unit 3 <br /> 7. <br /> Ed <br /> ❑unitl <br /> 8 p SITE MITIGATION <br /> 9. <br /> 10. +Q� <br /> Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACIL TYNEHI LE,,..//�� CU4q7 <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIREl1 >~ie S, l.C/ _of_ tit- q7 <br /> JUNDERGROUND ANK(MONITORING/REMOVAL ❑FOOD FACILITY DAIRY. L ;4 ;4 . <br /> ABOVEGROUND TANK o% ❑CHICKEN RANCH/DOG KENNEL WASTEWATER REATMENTPLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALSCr9 ❑MOTEUHOTEL PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING COMPLAINT/RESPONSE RECORDS OTHER(PLEASE SPECIFY) <br /> NIELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. "'BOXED AREA-EHD USE ONLY*** <br /> 74(44(0: U r <br /> D /9S5 s 0 n <br /> EHD 46-06 <br /> _�I4ktU v/&flS.foACo. 0 711115 <br />