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7 <br /> DATE RECI D YN EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ plv�" BUSINESS[AGENCY: <br /> ADDRESS: 1,c,, lo�& 'gvqvi C4. -A� CITY/STATE/ZIP: <br /> PHONE (1): (otto atas- :s-i:jk PHONE(2): FACSIMILE: dA_ <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-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE k2 <br /> Electronic information: El List El Map-Description: <br /> FILEADDRESS EHD USE ONLY <br /> Street# Street Name ity <br /> -9-61it i <br /> 1. Lo <br /> 2. 4Q(Q6iAr, C&S-a Fl ehit 2 <br /> 3. e�i) <br /> ZX1, G-11 <br /> INZ)Aftt<r 6111 6 n it 3 <br /> >�Mv <br /> 6. <br /> El-Unit 4 <br /> El units <br /> [I Unit 6 1 <br /> Specific Date Range of Information Requested: From lck4n to <br /> ENVIRONMENTAL HEALTH DEPARTMENT-FILES <br /> BUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 2NEDICAL WASTE FACILITY DIOLID WASTE FACILITYIVEHICLE D <br /> 2fTHER CLEANUP srTE(NON.LOP) El HOUSING ABATEMENT 2WASTE TIRE <br /> �NDERGROUND TANK(MONITORINGIREMOVAL) El F oo FACILITY 2VAIRY <br /> El-AgOVEGROUND TANK hWHICKEN RANcm/DoG KENNEL DWASTEWATER TREATMENT PLANT 2, <br /> ED-HAZARDOUS WASTEIHAZARDOUS MATERIALS El MOTEILIHOTEL 2SUMPERTRIJCKIYARDICHEMICALTO[LrTS <br /> [�]IIERED PERMITTEO FACILITY E'VOOLISPA E�[fAND USE APPLICATION SITES <br /> TAT-roo/BoDy PIERCING E4COMPLAINT/RrsPONSE RECORDS E3'OTHER(PLEASE SPECIFY) 9­15�% <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY+PjDAY 8:00 Am-5:00pm(EXCLUDING HOLIDAYS) ---EeW <br /> I. 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 receive r 3:00 pro 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. *�EIOXED AREA-EHD USE ONLY� <br /> rDi-'�JIQLD i6jj �ji, _D5 �21-C� L <br /> - <br /> 1"�5 I <br /> !f�LOU 10 Hcj -Pjj�- P <br /> mia"I co�.g_z c.,.0 jdc_j&& A�:�'007 r5j <br /> 51 caqle) 'k Ox- <br /> n" 1trier. J WP4 JzaLzIz q/5D jq&j=i <br /> lo2i (1,19ed-icA /,?c 44 COr� r2W't4C'f%) i,)-5j --,Perry . PaiictccA cz. ol -7w I'1d'4_'tr1a1-L4ST <br /> U-5r File 4 W-11' 5P'a_-9 AS�i f;i)-e� civ,�;_-to, Ljj4 je6kb Pbr -71,0 n[[��joj d�fr-> <br />