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EHD LOG NUMBER <br /> cEl EDI , SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC 2 a Z015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.6jgov.orglehd <br /> 0irn.PC r �I,� <br /> rC F Ccc PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:u0ty b BUSINESS/AGENCY: $E�1S( R RSS0c1R(E5, 1�1G. <br /> ADDRESS: t'4 32 <br /> CITY/STATEIZIP: <br /> ?O CCI U11 1 <br /> PHONE(1): lwt'm LY-Aq03 PHONE(2): <br /> FAX OR E-MAIL: Y(AWO t �rbK(��ASSD <br /> Please allow 10 business days from date of application submittal for the records to be available. ( Owe <br /> Staff will contact you to arran a an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITER UES - 130 FEE AS OR C CK REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT DATE 12 }/3 <br /> Electronic Information: ❑List❑Map—Description <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name -r� City <br /> v-t <br /> 1. 32"�1]� %-////1 v� rr��• . S \v�-�17� J / ❑Unit1 <br /> \ 2. rV l S UvN v��zkbt ❑Unit 2 <br /> 3. 3233 1,00M\S �D S'CoC?r'1 b N 4Gt, - - Z� <br /> 4. 2�2� S N k N'A%`A 2M,%K �D [I Unit 2H <br /> Q. S10(,k_Vb,Nl p nit I'�I <br /> 6. �j„2 1.OQ�C\\( lt,�,n1 p� S04�UU aV.� A No aw) Unit 3HM 1 <br /> 7. - 2-1 S C1��1 � 1-1 \KI!b Q-b S� cvly �W xJ1.(�I 1 ® nit4 <br /> s. 2� \A_\Ak5 V b . AID Uji, rE TION <br /> 9. ❑Unit 5 <br /> 10. <br /> Specific Data Range of Information Requested: From to 1111 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> cccccc������555555� 1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL []SOLID WASTE FACILIITYIVEHICLE <br /> HOUSING ABATEMENT ❑FOOD FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) H <br /> ❑ <br /> UNDERGROUND TANK(MONITORING/REMOVAQDC ❑WASTE TIRE ❑ <br /> DAIRY,POOLISPA <br /> ABOVEGROUND TANK O( ❑CHICKEN ANCH <br /> RI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE 1A ❑MEDICAL WASTE FACILITY E]PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> HAZARDOUS MATERIALS E-1TATTOoIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> ®TIERED PERMITTED FACILITYG(, COMPLAINT/RESPONSE RECORDS ❑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 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 approx'lointely to (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. App <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 /> (• Z-Ib'. ru ffEl I AQ, d -i0 R (,0 <br /> b, IC, co 3�6 6 r <br /> g 1'a <br />