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moi-. <br />DATER .CEwuu °�A,� ��' a �.y MBE <br />CSF± U SAN JOAQUIN COUNT`( O <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />AUL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />N�;� 1 66: (209) 468-3420 Fax: (209) 464-0138 Web: vwvw.sjgov.org/ehd <br />OIN9ERMCTIsER`�'PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 0 -o -CS ©�SC',r\ BUSINESS/AGENCY: r �! �n t V t , <br />ADDRESS: I ` ( P f; rL-e J-e� 1 CITY/STATE/ZIP: C,� <br />PHONE (1): ' Z�2 PHONE (2): FACSIMILE: <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 - $125 FE ASH Ofd CK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE (S^— <br />Electronic Information: ❑ List ❑ Map — Description: <br />3 <br />FILE ADDRESS <br />EHD USE ONLY <br />ElUnit 1 <br />❑ DAIRY <br />Street # <br />Street Name <br />City <br />❑PUMPER TRUCK/YARDICHEMICALTOILETS <br />❑ LAND USE APPLICATION SITES <br />d <br />❑ OTHER (PLEASE SPECIFY) <br />I� A5 S ❑ Unft 2 <br />2. <br />l Ct `tel o <br />l G G') � -S <br />�GF� � <br />3.InSral��eMP <br />J. <br />00 C i <br />,® Unit 3 <br />4. <br />I l C L <br />�. 1 <br />❑Unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From _ <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />ERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT <br />SUN ERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY <br />AB GROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL <br />AZARDOUS WASTEMAZARDOUS MATERIALS ❑ MOTELIHOTEL <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA <br />❑ TATTOO/BODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS <br />0 <br />❑ SOLID WASTE FACILITYIVEHICLE <br />3 <br />❑ WASTE TIRE <br />-bJe5 <br />j� 3 <br />❑ DAIRY <br />Uxk _`-4 <br />❑ WASTEWATER TREATMENT PLANT <br />7 -1 <br />❑PUMPER TRUCK/YARDICHEMICALTOILETS <br />❑ LAND USE APPLICATION SITES <br />❑ 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 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 END staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. ''BOXED AREA - EHD USE ONLY*' <br />jfj 4*'S t z '2 Klz �r3 5 c/g ane D <br />_Gle , ��g. u�3. ►lalt 3 : 2)Y,ID, 2�IFNZ , 31 L . 3yC7cj-- 55iy1' ovt,n l9liU Pira/; ` M-1) <br />_`1P_ <br />C/32iF� yf5.r[?i4+laL . ]tS IGfI,>5c: W-mun1,.,!A'/, XSJ01(oxi/. X`�,j eoq j, X -5Q 0178'3. ASJ OZO <br />Os��6L,XSJ VZitot,XSd V41gj,X <br />X=W 61151, SJoL29%j )(SJ 013Z,3,�jp243-D, arSJ 6223), Nsj 0.1)`1 <br />,X$,i, o3Lg7, XSJ 0� 25, xSj cis -Y7, PM✓&11 C b of i996 PKccyj rts-r M,,ir_Oi A r-ome n.f -W- <br />ohm <br />J 0 ZG <br />