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✓"'� 08 • <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> /moi L` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazeltoh Avenue; Stockton, CA 95205-6232 <br /> elephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov-org/ehd <br /> ;c <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> /ACJ <br /> APPLICANT: fP_ /��C[! 7 BUSINESS/AGENCY: C_Cc(Gl* - /te <br /> ADDRESS: (� j �% f ST, 2v jy�G—y�V CITY/STATE/ZIP: �CGCf/J`w Pi9A (!4 <br /> PHONE(1): r S— G 3 d PHONE(2): , 7Ik. a E FACSIMILZ3 <br /> T kT. TIV,E`APPOINTMENT DATE: rf> n i S C , Cf}. 60;_f 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 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_ -�O <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street tt Street Name City ❑Unit 1 <br /> 1. 6fol 5ell4dL6'- w is C t,._�6 N <br /> 2. fp>_ t r L 11 ,. U 01.102 <br /> 3, (r2 l r 1 <br /> 4. ��'L �' f I rNN� t)t y t UnIt3 /It� <br /> rak;n� `l� es(3brPPN i �3n CA's <br /> 6. E, Chi & /ti/aS Ck4q oQ �D E, lvl S]L_ unit4 <br /> 7. <br /> 18' \ ! _ 6 G a�A a�t( f ❑unit s <br /> 9. <br /> 10. f�tn' �Fn'f S fun � Wo SC• Cr/Unit6 <br /> Specific Date Range of Information Requested: From _�� to <br /> ENVIRONMENTAL HEA TH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENTSOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) F1 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR El CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ',COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List ua.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(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 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$126 deposit prior to review. <br /> EHD D5E CN'LY <br /> EHD 4846 811111 <br />