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q <br /> EHD LOG NUMBER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY �� f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �L 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 46&3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd ., ) <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: .Tas -tlo Q51OP 4 BUSINESSIAGENCY: ()521I;eAU \44MV Cbm1nokA7r r 1�^ <br /> I ADDRESS: -2$6tza 1h1 MAR< uk Lo CITY/STATEiZIP : 50focle moi j 162ts <br /> PHONE (1 ): bAcfl 7?)a% PHONE (2): 2 !0 • F <br /> -)I is FACSIMILE: qJ�� ` � <br /> TENTATIVE' APPOINTMENT D Time: <br /> (Please allow 10 business d fr date of appl cation sotttal - "Tentative only - must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ ST - E S CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESP DAYS <br /> SIGNATURE OF APPLICANT DATE 1Z /7113 <br /> Electronic information: ❑ List ❑ Map — Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street # r Street Name City ❑ Unit 1 <br /> 1 . <br /> 2. / ?J� Nl + {J� Z J�vCY 'o l ❑ Unit ? <br /> 31 <br /> 4. hoc? 646 <br /> 64 <br /> 6, I7 Unit 4 <br /> 7. <br /> g, C O unit 5 <br /> l <br /> 9. <br /> 10. Q Unit S <br /> Specific Date Range of information Requested: From t0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I <br /> UNDERGROUND TANK (USTI CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILRYNEHICLE <br /> OTHER CLEANUP SITE (NON•LOP) ❑ HOUSING ABATEMENT ❑ WASTETIRE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) F1 FOOD FACILITY ❑ DAIRY <br /> ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEJHAZARDOUS MATERIALS ❑ MOTEtJHOTEL ❑ PUMPER TRUCKiYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑ POOfISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATI'DOISODY PIERCING ❑ COMPLAiNTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1 . List u0 to tan addresses in the space above. Select the types) of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (20e) 484-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted - for additional assistance with file addresses, contact tris EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. 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. Appointment& <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked an by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file Is available. <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 applicantay "*ay require a $125 deposit prior to review. BOXEO-A 1. 7 Ti09VSVONLY <br /> tae e <br /> R®cordtspFovideti.tiyStale e.ffPFROomp s Nam . . <br /> EHD 46-06 61412 <br />