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�+ <br /> (DATE RECEIVED 25I {� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> V Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: kris4er Rh,' BUSINESS/AGENCY: pwL Fx�ro �,et io0 <br /> ADDRESS: 3'{oa Aoug![ t 81 ei ett• 7m CITYISTATEMP: IIe� llcF U9sL(cI <br /> PHONE(1): ot16 q�ls- 3-rTg PHONE(2): (g,� zz•t-3`lqo FACSIMILE: !t A <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE tomiy <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ,�Unit 1 <br /> 1' to la ut - .��c{a,n 1 Ar iMviP t Losp <br /> La 2. 1021 HM, NW A CBS it2 1(lU <br /> $. '150 �+MP f,a I NeCo� <br /> 4- -16o� })S r SwLcbp,�Unit3 <br /> e 5. lost {Is ntP � �cosQ I l( <br /> s. <br /> �nit4 <br /> 8. <br /> ❑Unit 5 <br /> 9 (� , <br /> 10. <br /> ❑Unit e <br /> Specific Date Range of Information Requested: From I gm to P, sd N <br /> �,,�! ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L�j UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) 2VEDICAL WASTE FACILITY [R�]SSOLIO WASTE FACIUTYIVEHICLE <br /> ntHER CLEANUP SITE(NON-LOP) [IU VHOUSING ABATEMENT ASTE TIRE w <br /> 2r;NDERGROUNDTANK(MONITORING/REMOVAL) El OD FACILITY 26AIRY u���•I� <br /> [�<BOVEGROUND TANK =KEN RANCH/DOG KENNEL [;IWASTEWATER TREATMENT PLANT <br /> D <br /> nAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL []-PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 01IERED PERMITTED FACILITY [ 00LISPA E�EAND USE APPLICATION Sn Es <br /> ❑TATTOO/BODY PIERCING [-`COMPLAINTIRESPONSE RECORDS []'ETHER(PLEASE SPECIFY) ag �'A ENTAL <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) �W-E%a <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.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 /> 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$130 deposit prior to review. *"BOXED AREA-EHD USE ONLY*** '. <br /> aI"II *r5 C 7 I�y7`1 )o - o v� Ile.. <br /> Cc>"5 pC(i34 txi- z2Z�= 4� zLHC f s 0tc lei <br /> c 760 ; f rl of,' oil o5i s 00, 3 )77 L <br /> ()(t flW Rv: { o ci T t/*'s XSJ"Co971 5yO/a1 XSJ 0,70 rvr 1010 i.t LGS11� <br /> Y1CidaRh t S / rSJ c141� X�J U2�1� XSIC x�oyo/7, XSj oUy61 �,- 102-1 1r1d11_4r1J- <br /> EHD4B-06 /Ip7Q •' 7(rA auIU�IT[aI <br /> i[Iud+utlrpl, xs�olll3 , xss Prv'��ditcl u/�4 1 '"t��' F'o�^ �i5-p /ndua °y'�'j <br /> j62_1 [n�u /d./1 (/'7Jed'� //7c d Cs'rn perl'ucls) t' /0151 --.per PrL/+ A CD q 7&0 I iJv_lr/a.f-LIST/ <br /> q5D „fdHsh-/av usr Hie It loll Spe•-r j AST ftily rJwL to /s, <br />