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DATE RECEIVED <br /> SAN JOAQIUINL(LOI"N�Ad�E l H1H '�. I "ON awi, l Pania�a8I� <br /> `,,, ���� ��D ENVIRONMENTAL HEALTH DEPARTMENT <br /> ley <br /> NOV 12 2015, <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone; (209)468-3420 Fax: (209) 464-0138 Web; www.slgov.orglehd <br /> . ``G'� R``'" `NTf Tic LTK <br /> PUBLIC RECORDS RELEASE APPLICATION' <br /> ----.�_. <br /> --- <br /> APPLICANT: o n to - <br /> SIN.ESSIAGENC"';: 1 <br /> ADDRESS: I �_ " �--�� <br /> ..-- s�":o r�. CITY1STATEf7 P: (r0 1 �' '2 Li <br /> PHONE (1), 2jD --1-7 O - PHONE (2): FACSIMILE. <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 tate and time to review the regvasted records, <br /> CHECK ear TO EXPEDITE REQU�$130 FEE(CASH OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT wt. DATE <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS <br /> Street it street Narne City EHO USE ONLY <br /> 2. IaPN5 Saz : <br /> 3. V)hor r�`� (2 r1 I unn� <br /> 4. R f �3 Iv f far �- Low , <br /> � � Llnit 2 <br /> r� <br /> 2- LQ f ) d r ,n-� 1 , u,�e zH <br /> s. QN o 1 2� I _ <br /> 7. 1 ( � f3nit s �r <br /> �', <br /> a 1 831 1\3hOS" `� n Le) ° E�sITElAITIGATiOI+t <br /> Unit s <br /> Specific Data Range of information Rsquesteef: From to <br /> ENVIRONMENTAL I-EALTH DE—PARTME FILES <br /> ( UNDERGROUND TANK(UST)CLUXUP SrrE(LDP) ❑MEDICAL WAS.--,FACILITY []5WASTE F�cIL17Y11/EHiCLE <br /> (�OT'H£it CLEANUP SITE(NODI-LOP) ElDOUSING� DUD TEMENT ❑SOUL) <br /> Teas <br /> UNDERGROUND TANK(MONFORINGIREWOVAL) ❑FooD FACiLrrY ❑DAIRYST <br /> AsovEGR0uNi3 TMK ❑CHICKEN RAHCHI DDG KENNEL ❑WASTEWATER TRFATMENT PLANT <br /> HAZARDOUS WASTEIHAZ4RDOU8 MATERIALS ❑MOTF-UHOTF-L ❑PUMPER TRUCKNAROICKMICAL TaiLETs <br /> ❑TIERED PERMITTED FACiLmr ®POCUSPA AAA <br /> ElLJti1lp Ejgt LlCATION 5fTE5 <br /> ❑ <br /> TAIT f7gri IDV PEFRCING Z CGuKAIMTIRESPOME RECORDS ❑OTHER(PL.WE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORAS ARE AVAILABLE FOR REVIEW.- MONDAY-FRIpAy 5:00 Am-5:00PIa(EXCLUDING HOUDAYS) <br /> 1. L t UP 12 ton jddreasys In the space above. 5e,iei i the type($)of files from the lit above by checking the epproprlate <br /> box(es), At least ane f410 type MUST be selected. Fax to(2091 j&4_0138 or mail to the. ddrgss Mica tk4 shave. Address <br /> ranges will not be accepted.Applications reeelved after 3:00 prn will he processed the neM business day. <br /> 2. For asalstance In Identifying the nature and contant of END records, please contact EHO at the number noted above. <br /> 3. The EHD will notify the applicant If any EHD files exist. An appointment for reviaw wIll be confirmed approximately ten(10) <br /> days after receipt of application. The tiles will be field for a maXiMurn of five buslness days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any fife not returned in the same condition as released will be reorganIzed by EHD staff at the expensa of thq applicant. <br /> Futuro file reviews by the same applicant may require a$13o doposlt prior to review. "1- <br /> USE QNLY1 <br /> e <br /> e� <br /> C7 recod=pro�vrldeldby Complete. staff Naym: md° <br /> END 4"0 <br /> v <br /> e ■ <br /> TO/TO 119~,� OCI tiV-9EL-GOT 9u :bT STH/TI/IT IN M <br />