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RECIEWED <br /> � SAN JOAQUIN COUNTY uSH EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 0 9 20V 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 0151!�O <br /> VNVMONMEWAL 1-tMTi'H <br /> pr;;mmSEIR` S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 611-t- V/c�A BUSINESS/AGENCY:. W1921W'tf" <br /> ADDRESS: g3,q0 aV4Vd;—'c:-­ GRCJWr S�IJI�L-'� CITY/STATE/ZiP: ,5 JJ;J j(/7/C7 r[� <br /> PHONE(1): 'J'/&" 3`��f 5;?d6P PHONE(2): c/j,4 3- 7-4091 FACSIMILE: 7/� SW-1/ .29Z? <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 E3dX TO EXPEDITE REQUEST-$130 FEE OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN SS DA <br /> SIURE OF APPLICANT DATE (�3 1117- <br /> '1A <br /> Electronic Information: ❑ List 0 Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 � + <br /> 4e AIJA11,6 Iq 411 <br /> r.P2. f Unit2 E t11t <br /> 3. AV,6 <br /> 4. 5 rYl ti-t r <br /> E j Unit 3 <br /> r" 1 L 490S <br /> s. t�� ;Ic II� i� r °c -use <br /> 7. 72 4460 SSS''/,D, ER �°kd✓ ' I` ' \ <br /> 8. ikco nit s <br /> 9. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES07rJ <br /> 9UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEMCLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH!DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑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 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 END 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 /> C . 4 q _ y ; G I J <br /> 41- ` r, L. <br /> 0 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD CA_l <br /> 48-06 .'L�,,�, �y <br /> K ,6 4 01610 -h <br /> ��,"C l� ,►i.f� Iry � ail a > L� -, <br />