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6 6 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .IOAQUIN COUNTY �. <br /> ENVIRONMENTAL HEALTH DEPARTMENT 1 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232il IT <br /> o elephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ky, t�( `Q A BUSINESSIAGENCY:�,�„ <br /> ADDRESS: 3� S• 1tl Ft /y.Ve #ZAj_ CITYISTATE/ZIP: CA <br /> PHONE (1): 20 `91:Vf% W� 7D PHONE(2):-609 4%_1 Z FACSIMILE: 2!0 %Ctl� �a7N <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-$13KEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUPINf SS DAYS <br /> SIGNATURE OF APPLICANT r- IW' t{J'V�^ �� DATE <br /> a <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS - EHD USE ONLY <br /> Street# Street Name City <br /> 1. Z35(c 5_ 5��• �e (�!. - p4v�✓�� l Sj 64_p-�_ <br /> L] Unit I <br /> 3. P <br /> lie <br /> Z?j(ts5 $ • cR l� tE� /lee • p A_`��2(v6 �1 n7JIIIC)� Fd it2 4- 'z3 7 e�CY. Q tV ro \G Vl ❑unit 211 <br /> s. ( zq2� ( Ws9or, C.IT (✓tic�a -14- <br /> 5. l Z Z rs(v seo� r✓ (mac. %-k"P-00 te- =(kI V 3 <br /> � h <br /> 7. $� j. ` y LoC.�t r it4 <br /> a. 2q,70 l cr_J 6s^(1Loc Irl t u k � I A N <br /> d <br /> 9. L �ac�ce L6, lvcLt +,� <br /> f 0. gC�(zZ 1 , t� zlti $�5 Lr�lcsa c w . M 5 wbt'c0 aE4nit <br /> ,p ttrt Specific Date Range of Information Requested: From I to ry---^' <br /> t ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> dG NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY E]DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL E]WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS FMOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY PDOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TAT001130DY PIERCING COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) (1•� (� �- <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIL �LEFOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up ten addresses 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. "'BOXED AREA-EHD USE ONLY`** <br /> jWjej Yi 06 falwt Lo r (o• Z'. (0c") 1144,5 (.,,i ,5 e (- -e lar 1 ' -F J I '67 a.11 <br /> ccs e fl RJ <br /> Q �4�1 .nLt e0. Nv`tde� tnS 41 Ib(9Cv7 tik 8 e/�. /v.Uel <br /> 1.4 L C 12 V7 <br /> ❑ Records provided by aff-PPR Complete. Staff Name: <br /> ENO AMS 711115 <br />