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AP r. 1l. ZU14 4: 24Y11 No 116h P. 2/2 <br /> DATE RECEIVED EHD LOG NUMBER �'- <br /> EC)EWEy, SAN mJOAQUIN COUNTY <br /> D ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Melephone; (209) 468-3420 Fax: (209)464-0138 Web: wvvw.sjgov.org/ehd <br /> RtJRlPAEi %:"E V PUBLIC RECORDS RELEASE APPLICATION <br /> PE <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: 3s61 W. CL�pM s7. s7-r_ CITY/STATEIZIP: t o,sr _in 83 �s <br /> PHONE(1): PHONE(2): FACSIMILE: Z,,3 — Jog - -f4�-ei <br /> TENTAT/VE`APPOINTMENT DATE: Time: <br /> (Ploasa'allow.10 business days from data of appileatlon submittal•-Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> Electronic Information: 1st❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Noma city ❑Unit 1 <br /> 1• �`61 Sw�Fr W�� STG 4�-.-oN Ami iiM lie , uSi U•`� <br /> 2. Hh�Mp >iL da G <br /> [3Unit 2 <br /> 3. <br /> 5. ISI <br /> 6. <br /> ❑'colt 4 <br /> 7. GJ <br /> 8• ❑Unit S <br /> 9. <br /> 10. ❑,Unit s <br /> Specific Date Range of Information Raquosted: From to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE 6� Ile' <br /> THER CLEANUP SITE NON-LOP E]HOUSING ABATEMENT ❑WASTETIRE °J 14 <br /> UNDERGROUND TANK.(MONITORINGIREMOVAL) El FOOD FACILITY El DAIRY LIQ zr1- ' <br /> HBOVEGROUND TANK [j CHICKEN RANCH/DOG KENNEL E]WASTEWATER TREATMENT PLANT <br /> AZAROGUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK[YARDICHEMICAL TOILETS <br /> ElTIERED PERMITTED FACILITY F-1POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS E]OTHER(PLEASE SPECIFY) <br /> WFLL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:OOPM(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 /> LL <br /> box(es). At least one file type MUST be selected. Fax to(2 09)464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for reVlew will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold for a,maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the ap licant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. 9oXED� <br /> PP Y �''"��. . . .. . b'. 'E'ONLY <br /> z(-1-14 1`112- C Ot tA24 cf 8 61c 5 0t' ('11-F cx1,k00 Pile, <br /> tMAS I 91rJ1:6-[C111.j <br /> sS6c k-"J Ckad IAgn .. le. - Ic4 e <br /> . e ST Ilei _ : � . . 1 89 511 41' -iT7 41t <br /> e-HD 4e-06 CVa4 jt+o w61.r-f & LL k in iT 'hO/,'Ow +ro J0,Uj e(1V tj,,. Fles�ar'C�i 4yk <br /> VV,Ii rAcol <br /> til N' Ov wMplCunt- s•7(vm^er0r( 6Jhlo wife <br /> Received Time AP r. 1N014 L:i� M ��� <br />