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t-` f y EHD LOG NUMBER <br /> SAN,,JOAQUIN COE NTY ��+"J <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> , <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232y ? <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:v ww.sjgov.crg/ehd <br /> PUBLIC RECORDS RELEASE APPL�CATION <br /> ��-i.,:.r,€_� -fes- � :-.-'GCi�tk-l�• f✓t(l,�J }fL-( IC�'� �s 'c�';r�' <br /> lrr• �'€9 C� <br /> I ;t0QRE55: �"�?�S FI�f•('.1t1r'c�S�'t i..t'i r �'� ��r!• '���1,�'�,f-- GET'��IS T ATCIZI P: ��..�r�ri ��'- ���'r�I <br /> t71 !f [.. L f; !'rRs ..f E% ¢I �LGI IGE t�fe{eC��i'.�.rS tU IL,iir aiI`aliaule. - <br /> I IeaaE atlG`v �� L=EiSi!ict�i���.t.� s: .�E .�=tG _I el::E� tiy.Qit SJ�tS;i <br /> Staff wlil contact you to arr i ge an appolntrnent Cate and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINFSS DAYS <br /> -7/ / <br /> SIGNATURE OF ADPL APPLICANT f��f 1� �+;=F �. . SATE �� rr �� <br /> 1. List up to ten addresses in the space below. Select the type(s) of fifes from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 269 464-013$ 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 END at the n;.giber 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 receip"of applications. i he flies 1viil be held for a maximum of rive business days for review. Appointments � <br /> should be scheduled accordingly. <br /> 4. Anv fife not returned in the carne condition as released-ili be reorganized by EHD staff a_the expense of the applicant, <br /> Future file reviews by the same applicant may require a$130-deposit prior to review. <br /> FI'<fELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 ARI-5:00P10(EXCLUDING HOLIDAYS) <br /> ElectI Infornrtation: ❑ List ❑ Map— Description: <br /> Specific Date Range of Information Requested: -From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE <br /> FILES €'� <br /> NTANK(UST} Street# Street game- City f __ <br /> fuGCEnNJCP"SrceDERGRouND'(L_0P) — <br /> If f THBR CLEANUP SITE(NON-LOP) r� il N( � <br /> ❑HAZARDOUS WASTE I [ ❑DAIRY <br /> TIERED PERMITTED FACILITY <br /> II FABOVEGROUND 1 ANK <br /> [PINS <br /> UST (r:70h!ITOR!N^/P.EF.t OL7tL) � <br /> HAZARDOUS MATERIALS <br /> SPIL-URELEASE RESPON5E <br /> f - ❑WATER QUAIJTY <br /> II SOLID WASTE FACILITY I VEHICLE I 4 <br /> FOODFACILITY <br /> POOL I SPA E SITE MITIGATION <br /> {DAIRY <br /> ❑LAND USE APPLICATION SITES - <br /> SrPT1C PUI IPER TRUCK/ ❑HGVSIhfG <br /> s <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATIAENT PLANT []CIJRA <br /> NOUS ING ABATEW ENT 7 - <br /> []MOT£LIHOTEL <br /> ❑CHICKEN RANCH I DOG KENNEL ❑CUPA-HAZ-MAT <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING <br /> ❑soLlo wasTr: <br /> WASTE TIRE 8 <br /> GI COVPLAINT - <br /> OTH£R(PLEASE SPECIFY): ACCOUNTING <br /> 10 <br /> :- 10111 AR1=a.ENa Use 0KIQ • <br /> El Records provided by Staff-PPR Complete. staff Name: <br /> EHD 46.06 <br />