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PATE RECEIVED EHD LOG NUMBER <br /> L) SAN JOAQUIN COUNTY <br /> 0 ENVIRONMENTAL HEALTH DEPARTMENT <br /> I <br /> hp Al 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> --� T�lephorie�(209j 468=320"Faa�:(209)464=0"'I38�WEb: www.sj�ay.orglehd - <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: EVIL) v-, OT BUSINESS/AGENCY: 44f/ <br /> ADDRESS: X2-/2- 111. 7_1Z4C"Y p{-VJ -t+2z CiTY1STATEIZIP: 7K4 C� <br /> PHONE (1): S '-/�7- %Z-y3 PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 4S " Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU (NESS DAYS <br /> SIGNATURE OF APPLICANT 1/_1.. � DATE S-,s-lf <br /> Electronic Information: ❑ List❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 Unit 1 <br /> �. 7S"7 7 r/i S i C Y <br /> 2. 70' z� El Unit 2 <br /> 3. fI <br /> 4. / <br /> ,•Q Unit 3 <br /> 6. 2rUnit 4 -� <br /> 7. <br /> 17�`le s jt��r- C�ifl <br /> 13. <br /> ❑Unit 5 i <br /> 8. Dth.�v -7l9//,S <br /> 110. <br /> ❑ Units <br /> Specific Date Range of Information Requested: From �tC-(_ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ©UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY/VEHICLE <br /> ©OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ©HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMJCAL TOILETS <br /> Q TIERED PERMITTED FACILITY' ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOolSoDY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW:-MONDAY-FRIDAY 8:00 AM-5:OOPM(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-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 expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review_ "''"`BOXED AREA-EHD USE ONLY—- <br /> ,__0 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> E HD 48-06 <br /> 914112 <br />