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DA EE(Y EHD LOG NUMBER <br /> E i SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC 1 2495 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd IIIJJJJ <br /> ENVIRONttaENTAL14ElLT14 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: S �' e :� („ C� ,Wc- <br /> ©'+/ (�;,�/qty t_ BUSINESS/AGENCY: ��£fJS t; ->u�CcF f <br /> ADDRESS: {ct [� ,,,,, - S.free-� CITY/STATE/ZIP: <br /> PHONE (1): ;S 1, L(-^r(�,S-Gf30 PHONE (2): f✓S(., .7„ G ",'•.' FAX OR E-MAIL: " J f,i 4.( <br /> Please allow 10 business days from date of application submittal for the records to . vailabl'e. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUE t$13 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT� jjDATE <br /> Electronic Information: E�i`st❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name city <br /> 1. 6 �1 _G� t CWT- wAv ` 1 n tA5-t `Cof (00'-p Y-1 ((ro ❑Unitt <br /> 2. a 1 11-� , <br /> 3. ,;Y P'13 91nit2 <br /> 4. <br /> NF� E]Unit 2H ,r <br /> 5. j et i 11tr-c4 Ltiy-r-cA .,P 94mt3 ►� <br /> s. `, , !d(kAr1� I(• J <br /> .7tT <br /> �Cz��^c :urW• �(. Unit 3HM <br /> lea' l lam. (A4, 971k WJAl •__ ca 4it4 <br /> 8. , <br /> Eg"SITE MITIGATION <br /> 119. <br /> 0 <br /> 0. Tor <br /> Specific Date Range of Information Requested: From to 11 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES31 <br /> !.' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTEL/HOTEL SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT FOOD FACILITY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑WASTE TIRE ❑DAIRY,POOL/SPA <br /> ABOVEGROUND TANK E]CHICKEN RANCH/DOG KENNEL .r4 WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE E][:1 <br /> MEDICAL WASTE FACILITY PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> HAZARDOUS MATERIALS [:1TATTOO/BODY PIERCING [:1LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY [:1COMPLAINT/RESPONSE RECORDS PSOTHER(PLEASE SPECIFY) WO <br /> f/ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List uo 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. <br /> ***BOXED AREA-EHD USE ONLY*** <br /> ' Pvu lei 5 I'Lv N Is1 t{V fite o/ I�o� and It3y <br /> Cl, fog 1 t C p o R�713E i ' v j.0 I�o " (00_jo'ln <br /> co43'1 ;S I^ 4 L, file t o I%Ll Lt,r,•rro/ In r O 1 r LOoo I(o � <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: 9dY Eo( 914xg. v �. <br /> P014t COW?W,' ' L01[7033oG_�, c..Jl LOWTa 063 L-kr 1'25 (-L.wt'e/ Uwy V1,., t:0 . <br />