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DATE RECEIVED CO <br /> ��SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 'v' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvww.sjgov.org/e111 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: kl <br /> �p cle BUSINESS/AGENCY: <br /> ADDRESS: 7 .�U CfE"6_� rJ�Jll� -5011;!2FCITY/STATEIZIP: .� � /�J� %� <br /> PHONE (1): ' �F,/ 5Z�g Q PHONE(2): .1'Z 7vT/ FACSIMILE: 9/,:� 51-21,VV <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUE T x$125 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN1 DATE C19129 / <br /> Electronic Information- ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1• 3751 Al, ln.//L W4 Y� a p MAhP cast' <br /> 2' WI L-Jrd At/ 7 dC d tl94ly Noc�sQ ❑Unit e <br /> 3. �Qp f `�L f� .4 Triit� � RM cosy ` n <br /> 4. d ° I L aAl k4 YNIFF .-`TUC N nit 3 <br /> 5 OS� Al, /LSv' M4 S'jce 7o a .Iwt rose <br /> 6. Ali VJLSU` 0 4 MKT vle� 'ta oco ++a«.rD rvnit4 <br /> 7. <br /> a. <br /> Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 8 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES }� <br /> INDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSINGABATEMENT ❑SOLID WASTEFACILITYNEHICLE <br /> THER CLEANUP SITE(NOWLOP) ❑FOODFACILITY ❑WASTETIRE <br /> NDERGROUNDTANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACiLffY ❑MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> ❑TATTo01BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILRY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:DOPM(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(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END 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. Afile that Is actively being worked on by END staff may not be Immediately available for review. Anew application maybe <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> dlded c xss-o D 0 Por 4DN w',16L, <br /> etJV6r Sqjr5 Wicoasink-hon) so ad vancgjv ron�I <br /> o C[ I67s�m{'� co Frle 4c&I aJv/tee <br /> ' <br /> Eroae.oewll5on .s in conFyc(QnhcL/ 5echon of HroJ Fi/e dri- <br /> P 5roLo rn KIM,e,;mpliur�c.,a, secfla� �. <br />