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R . <br /> / ,-3 <br /> DATE RECEIVED AHD LOG NUMBER <br /> SAN JOAQ IN ONTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 [)4W* <br /> ephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ql <br /> v PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: 3o A4 <br /> ADDRESS: IbLI B2orf�Q2 CITY/STATE/ZIP: jN�cr►f� ` �°L <br /> PHONE(1): PHONE(2): .1j 30 FACSIMILE: 15r30^G33 —O)f I <br /> TENTATIVE*APPOINTMENT DATE: ASoffit /IafI40 94-- Time: <br /> (Please allow 10 business days from date of application submi I"*Tentative only,must be confirmed) <br /> - 25 FEE ASH OR CHECK ONLY -REQ EST PROCESSED IN 3 BUSINESS DAYS <br /> � CHECK 80X TO EXPEDITE REQUEST $1 (C h ) � <br /> SIGNATURE OF APPLICANT(fir- Vl Gi ZDATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name ;5C <br /> ity ❑Unit 1 <br /> t I <br /> rnl t I <br /> (J f2�R/t �--Gt.t.� I /T�V� d� ❑Unit 2 <br /> 3. v ,E <br /> 4. p �Unit 3 <br /> 6. &nit 4 <br /> 7. <br /> 00 9 <br /> 8. \\ ��I El Unit 5 <br /> 9. 1` � / <br /> 10. fi7 Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY Er§OLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT aWASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) F1FOOD FACILITY F-1DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> [HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL Q PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> [.TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOoIBODY PIERCING COMPLAINT/RESPONSE 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 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 Records provided by Staff-PPR Complete. Staff Name: <br /> 9/4!12 <br /> EHD 4"6 <br />