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DATER CEIVED EHD LOG NUMBER <br /> }{� SAN JOAQUIN COUNTY <br /> 11 ! � 60\ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,CA 95205-6232 <br /> 0 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> TT PUBLIC RECORDS RELEASE APPLICATION �O <br /> APPLICANT: 64vr1taT� BUSINESS/AGENCY: (3F42irieAL, JAI Loy �n+muAp,Y bw>t <br /> ADDRESS: CITY/STATEIZIP: S'rCckyz j CA 1,5zlc( <br /> PHONE(1): _�i(tl-7$� PHONE(2): �/�? "/O�T� FACSIMILE: <br /> TENTATIVE'APPOINTMENT D Time: <br /> (Please allow 10 business d fr date of appl cation submittal-•Tenfadve only-must be conflrned) <br /> ❑CHECK BOX TO EXPEDITE REO ST• 1 FE AS CHECK ONLY)-REQUEST PROCESSED IN 3 BUINES DAYS <br /> SIGNATURE OF APPLICANT DATE /z 177, <br /> Electronic information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street✓I Street Name city Unit <br /> n 2• 135 Mtu�sC 5�ae-o 1 /11/11 �/] ❑Unit2 1 ' <br /> 4. <br /> $ Unit s <br /> 7. <br /> 8. <br /> 8 J Unit s <br /> �� <br /> 0 Unit e <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1JNDERGROUND TANK(UST)CLEANUP SITE(LOP) ElMEDICAL WASTE FACILITY <br /> -1 SOLID WASTE FACaR1'NEHICLE// <br /> OTHER CLEANUP SITE(NON•LOP) El HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)� ❑FOOD FACILITY El DAIRY )CA <br /> ABOVEGROUNDTANK E]CHICKEN RANCH/DOG KENNEL El WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTHHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMIcAL TOILETS <br /> TIERED PERMITTED FACILITY [-IPOOUSPA [I LAND USE APPLICATION SRES <br /> ❑TATTOOIBODY PIERCING ElCOMPLAINTIRESPONSE RECORDS El 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 types)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-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 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 /> 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 Ole 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$125 deposit prior to review. M'@pXEti � pt+Ly <br /> lip— 1:4m <br /> 0, Lia <br /> x. ; <br /> _ ::... <br /> _ y <br /> x. <br /> END atae ,_ . ... ._ <br /> "/1 7 U T���F""Ile n Zlrfin- QOM �J'C.Aw - U!5-T 6aeA <br /> 14 z r(3. P�41JIIAW at11Pnni G t0 L'i'Al U9? {iI�5 fo� (30 0� 4 IVz t}tA4k.,- r6 � <br />