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DATE RECEIVED <br /> 1EHD LOG NUMBER - <br /> SAN JOAOUIN COUNTY LE G 14' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> iy� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> A�Q <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd `t <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: vis4ev� BUSINESS/AGENCY: Prvt <br /> ADDRESS: 3�(0� Omue�(a+ -bleat She• ?oo CITYlSTATElZIP: lI«cHlLct (� b�l <br /> PHONE (1): PHONE(2): FACSIMILE: r/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 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street;# Street Name City Y ( Unit 1 <br /> /~ lc to 1 tattri[eV Iv d. i tL i \ G <br /> tc2lI I ❑'Unit2 1 / '. <br /> 3. cl15o <br /> 4• 160 �� Q"Unit 3 <br /> 5. 1os� <br /> 6. <br /> ❑Unit 4 <br /> 7. <br /> 8• ❑Unit 5 <br /> 9. <br /> _ I� G� <br /> 10. J� <br /> ❑unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r j ° <br /> [�GuNDERGROUND TANK(UST)CLEANUP SITE(LOP) 2VEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE ji jf iri ` <br /> 2.6THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT Q-WASTE TIRE <br /> ©TINDERGROUND TANK(MONITORINGIREMOVAL) ❑Fq,OD FACILITY [AIRY <br /> EJABOVEGROUND TANK HICKENRANCH/DOG KENNEL [;IWASTEWATER TREATMENT PLANT <br /> ED-9AZARDOUS WASTEIHAZARDOUS MATERIALS ❑MMOTELIHOTEL ['PUMPER TRUCK]YARDICHEMICAL TOILETS <br /> ❑`TIERED PERMITTED FACILITY [J r000SPA [�'CAND USE APPLICATION SITES <br /> ❑TATToOIBODY PIERCING ❑-COMPLAINTIRESPONSE RECORDS ['OTHER(PLEASE SPECIFY) � �r <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.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 /> ❑ Records provided by Staff-PPR Complete.staff Name: <br /> EHD 4M6 OBI01114 <br />