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EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> /5911 <br /> A h <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> e elephone: (209)468-3420 Fax: (209) 464.0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ION <br /> APPLICANT: <br /> �th L1Q BUSINESSIAGENCY: <br /> r <br /> ADDRESS: n e�4 -Z vt -_(!k:At CITYISTATE21P: 0:1A (e <br /> PHONE (1): 20�c6PHONE(2):—?_J 9 � ! �` FACSIMILE: ?_0 <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-$13 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INSS DAYS <br /> SIGNATURE OF APPLICANT � DATE `3 lc j " <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. 4 S(a �w 2�v- --t€ MFI� ❑Unit 1 <br /> 3. Z-5 lE 1 5 . t.` G�� 124• �l��iyrj j ejt,5/ 4 t it 2 <br /> 4. 2 ] � _ 1 i �" "� ' in Unit 2H -. <br /> s. zq2 3tcr5sc�, �_ c,;'TGOck . <br /> 6. .� �tl Sip lni` ��—W t-+�w wti��C� L� _gel'n��t 3 <br /> 7. cO A�. � g� ri JC�`C I ' nil4 <br /> e. -2-4-To ur� te-6, Loc, Yd I A N <br /> 0. `'!?(�� �° s L�c Zk L • I �e_lb C x.7-�-. _1_ s <br /> �itCa Specific Date Range of Information Requested: From I to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> fHNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYiVEHICLE <br /> OTHER CLEANUP SITE(Nom-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONI T ORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AmDous WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑RDOLISPA ❑LAND USE APPLICATION SITES [ I <br /> ❑TATTOOISODY PIERCING COMPLAINTIRESPONSE RECORDS WTHER(PLEASE SPECIFY) ( <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIL LE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:O0PM(EyrLUnING HOLIDAYS) <br /> 9. 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 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 /> S13 tqwt Cal- coup 114's (", '51 ' - <br /> 1 e {{.� I A L/J, (ir 1I e-!- On," CA Kra 'l e r� t ��R�4 <br /> *-A'%L'k Vat �. lNd{tr�e� tnS 4-1 ib* to S C/,. It74Ue�lC�� <br /> ❑ Records provide� bal Zff- RnComp— <br /> Staff Name: I{ <br /> anus <br /> EHb A"R <br />