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RECEIVE® <br /> JY r rIj��E'Ml SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> O uu'' ENVIRONMENTAL HEALTH DEPARTMENT <br /> NAL F�' TH <br /> �� AE1tII������ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PE Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_��(tc vie-A BUSINESS/AGENCY: K,7DD19Z4A1le /1SSvL//)-T637 <br /> ADDRESS: ({�j Ci 452,Q44I6;,5 C-Rdt4: SV17'�c F CITY/STATEIZIP: iD j :�f /�j2�`f/ <br /> PHONE(1): PHONE (2); 9/4 6? jy ?Za9l FACSIMILE: ?/,-, 7'9 2.72,? <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 OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 0-7-10-57117- <br /> Electronic Information: ❑ List Map-Description: <br /> FILE ADDRESS �EHD USE ONLY <br /> Street# Street Name City <br /> 2. /Sa LkO S',/Wfy _ fAl a. H A66. 419 �i�/Qa,� � ' <br /> 1.An/RA tfbv Rv li�G1D ^rt't' � Cul(� -�7 1 <br /> 4.,4140 V. L,9THRaP RaA,o <br /> 5. <br /> • 8 L9� <br /> J+ <br /> 8. Mbf <br /> 9. <br /> r 5 <br /> 10. T <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 FACILrrY/VEHICLE <br /> OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELMOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL 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 flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)484.0138 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 flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 /> ❑ Records provided by Staff-PPR Complete. Stan Name: <br /> EHD 46-06 <br /> 06101/id <br />