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DATE RECEIVED FILE COY EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY 11kb <br /> ENVIRONMENTAL HEALTH DEPARTMENT �\ {A`VVVV <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLICRECORDSRELEASE APPLICATION t� <br /> APPLICANT: V 1 m I 1 r t Y'� ,tiBUSINESS/AGENCY: C.Sr-A 'b <br /> ADDRESS: 2 Li 1 .F fa^)_ WA s� Cir 4-1. Op CITY/STATE/ZIP: S—+O <br /> PHONE(1): '?,09 983 HOS 8 PHONE(2):`1'$ 39 2 l-9 Ll$ FACSIMILE: 'bC "1 '163 (o S 3 y <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST 51-225 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> —5 <br /> SIGNATURE OF APPLICANT 7�t_:Nt� DATE <br /> Electronic Information: ❑ List Map—Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit t <br /> 1. 29-z9 S 9 Q n c-W or i✓s �/r v� /e Nva <br /> 2. ❑Unit 2 <br /> 3. t+ r <br /> 4. N« ❑Unit <br /> 5. <br /> S. <br /> ❑Unit 4 <br /> 7. <br /> 8. <br /> ❑units <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT [:1 WASTE TIRE <br /> _;RVNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATERTREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑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 12091464.0138 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 file not returned in the same condition as released will be reorganized by EHD staff at the expenseof the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. 'tbbXED AREA-EHD USE ONLY <br /> 7 <br /> Nom. �1 <br /> Records provided by Staff-PPR Complete. SaffName: <br /> EH <br />