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DATE RECEIVED ti8�O 'ON 061 :6 ZIOZ 'fl '1nr+;Wl j paAIa3;� <br /> SAN JOAQUIN COUN t Y <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTiviENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ,JUL I Z01Z Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVPE08M�ES RVICES TH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,1 7 BUSINESS/AGENCY: !/S L=h✓, 1��/1/�'►P� r <br /> ADDRESS: �/5�0� pc ,V'2 C�S� t_'Q CITYISTATEIZIP: �t7rXkoD pl S3S� <br /> PHONE(1): ADI--7C,9-_761&D PHONE (2): FACSIMILE:_2i)Sj-X57-ZZZI <br /> TENTATIVE"APPOI NTMENT DATE: Ju 1 Time: /o:ae7 4,,, <br /> (Please allow 10 business days from date of plica ion submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$12 EE(C CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT `' DATEII/5(J/2, <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City it 1 <br /> 1✓v 2. S 4_,_ ��Ir <br /> nit2 <br /> 4- Unit 3 <br /> 5. <br /> 6. <br /> [.j�Jn it 4 <br /> 7. <br /> $. <br /> ❑ Unit!i <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From 2 to ✓P S .,7� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> i 'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT []SOLID WASTE FACILITYNEHIGILE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIREIC�� /fJ�l�+�, 3 <br /> UNDERGROUND TANK(MONITORINGIRELIOVAL)OA- ❑DOG KENNEL ❑DAIRY .X11-(Z IU3 <br /> jRHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRU CKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLJSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERNBT RECORDS ARE AVALL.ABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Selectthe 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 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> 2rj`I . Cts -✓1 's � y � - ame Ci <br /> EHD 48-06 6H/11 <br /> I <br /> I.'d LZZZLSC60Z UOSI8N aZZ:60 ZL 2L $ <br />