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DATE RECEIVED EHO LOG NUMBER <br /> r SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> / 1868 East Hazelton Avenue; Stockton, CA 95205-6232 <br /> elephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ,! I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> / �J <br /> APPLICANT: f?fp_ / 4Q/�l n BUSINESS/AGENCY: C_Gc1�fA - ��T✓ � <br /> ADDRESS: v ��/ J//. X,—OCIT,YJ/STATEIZIP: j�c-/- <br /> PHONE(1): ZSS- G 3 a PHONE(2):n(i '.r �!17Y"/�i'I FACSIMILEl9/G�'2-- <br /> T -NT T/VjE"APPOINTMENT DATE: OV Q T,y C /, God Time <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST C OR CHECK ONLY)-REQUEST PROCESSED IN 33 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� ? �� DATE 91/O/Z_ <br /> Electronic Information: ❑List❑/Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street R Street Name City ❑unit 1 <br /> 1. p FellaLr�tr ti tic �T7 <br /> 2. ❑Unit2 <br /> 3. <br /> 4. �8"2� p �. f ( piJ' l)t r 4 I \iUnit3 <br /> 5 e�(A -c c- E :4 fi ' L n< N F7e7 (3 gripe / �(j IS <br /> 6.. f�h7a /.r) ;,/a-S C�ia-n 7 p �, �nf SF-� Unit <br /> 7. <br /> 8. o-i It a� �VO'(41,9! ❑unit 5 <br /> 9• vd 13'a u h / �'Cl, r W� /fin - <br /> 10. •{-Ailrt �Fa1 thr`S ran 5'e_ w° SL G Fri 1. Wunits <br /> Specific Date Range of Information Requested: From �� to <br /> ENVIRONMENTAL HE TH DEPARTMENT FILES , <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT �E SOLID WASTE FACILITYNEHICLE <br /> —ffOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOvAL) ❑DOG KENNEL ❑DAIRY <br /> HA7ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑-MEDICAL WASTE FACILITY .COMPLAINT 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-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day, <br /> 2. The END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten(16) <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 END 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 END staff atthe expense of the applicant. <br /> Future file reviews by the same applicant may require a$126 deposit prior to review. <br /> EHo USE OrnY <br /> EHD 48-88 - 811111 <br />