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DEHD LOG NUMBER <br /> ATE RECEIV D <br /> C� J SAN QUIN <br /> UNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Wf 7 5,5f one: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> T <br /> y0( elyvyl/ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (// /1 BUSINESS/AGENCY: 11-11R 'J <br /> ADDRESS: D ✓�� (J/T CITY/STATEIZIP: 9Sr <br /> PHONE (1): �f/(o j�n `1 �e200 PHONE (2): 9/6 .2?j NgL FACSIMILE: g/6' _3 1� 2 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑ CHECK 80X TO EXPEDITE REQUEST-$14¢FEE(C R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSS)NESS PAYS <br /> SIGNATURE OF APPLICANT , DATE <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> (�L �. 3�t3r W1L.,Sc7rP0 /iS Uc 7' o M <br /> V" 2. w11-S0,41 X✓ IF <br /> , (fC M ❑ Unit 2 <br /> 3. W,#y �i11�'�fi/// <br /> 4. (- j yz l E � kl,T_ f7'(J /f/ n Unit 3 / <br /> 5. too' yN.f F 7dCtlyo 90' n <br /> s. 4 ' Al, Wlt S%�/ W,#Y 57(ac T <br /> 7. 4000 N, WIL5041 :Marly <br /> S. BR-✓`01N XIAY ifA` ❑Unit 5 <br /> 9. 4103r /Il ItIlai7AI K/,t�-i <br /> 10. ❑unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE F //''( <br /> C%YNEg;LF,.;,� <br /> THER CLEANUP SITE(NON-LOP) El FOOD FACILITY E]WASTE TIRE --- F I PP <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)q% ❑DOG KENNEL ,. ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILRYV__ ❑MOTELIHOTEL ❑PUMPER T,RUCKKNARDICHEMICALTOILEBs <br /> TATTOOIBODY PIERCING -rhe <br /> /V 1lovilli �mj � aNL glwn n I t' ' fiv a 0 w 14 <br /> ❑ MEDICAL WASTE FACILITY I YI J <br /> WELLAND SEPTIC PERMIT RECORDS ARE F les = <br /> gOnn Wi150n -CDOOD5E94 gi51ob in 14Wfile, <br /> 1. List up to ten addresses in the space a �p0ppp y 0-5, pe,f 510Bo i n ({W {z le <br /> box(es). At least one file type MUST b/ (S 0780 r <br /> ranges will not be accepted-for additi HQOI W. <br /> 3:00 pm will be processed the next bw ' co001-jq 7 r+W (? <br /> 2. The EHD will notify the applicant if any ND 35 W,I tpf)02! 6!E OttJP b5. NA Lt 0/2 :n 4W Ric. <br /> days after receipt of application. The f LID 55 V„11,404 - EDD0 W3( - OZ'Out 2 COP�FS r0fW1),wr <br /> should be scheduled accordingly. I- t(40� OOf S ID(o iA fltA Me <br /> 3. A file that is actively being worked on I o- 4 0 a 4./V,l.�dq ted(o1L 90 i�r' <br /> submitted when the file is available. 14106 51 �fl-5106 ;n Fka.1 h�L, <br /> 4. Any file not returned inthe same cond - tU DO 180.(0(9;PPf 5106 'r/i tt(N F.J6 <br /> Future file reviews by the same appiica „n Qy <br /> IIF <br /> tr }( e l8� D I n <br /> 4t 3' vj. a o ` �4 <br /> i 1A K) r <br /> EHD 4M6 <br />