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DATE REQEIVIr.D,� _ - ;l EHD LOG NUMBER <br /> L I, i'0j SAN JOAQUIN COUNTY n <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Oil] 600 East Main St_ Stockton , CA 95202-3029 <br /> F II <br /> TE <br /> shone : (209) 468-3420 Fax: (209 ) 464-0138 Web : www. $)gov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KviStan t>.tt BUSINESSIAGENCY: FtAtvcav , .� .rt � ,t, <br /> ADDRESS : 3a*rl W"aw 1, AW S t'( f C CITY/STATE/ZIP: &1&vftW <i. t Lel cht7•t <br /> PHONE (1 ): f�{,� rtto 0L3b PHONE (2) : (SV*) ZZI S l`lo FACSIMILE: (4LI.) 4$ S <br /> TEN AAPOINTMENT DATE: Time: <br /> (Please allow 10 basiness days from data of application submittal - •Taetaf(va only - must he confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REOUES - $122 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 4f ISj •e <br /> Electronic Information : [] List ❑ Map — Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 7! Street Name City [71 Unit 7 <br /> 1 . <br /> quo <br /> ( .. <br /> Unit 2 <br /> 3. { (� <br /> 4. a55 . s� "l <br /> 7. <br /> 8, <br /> _ ..._.__— ❑ Unit S <br /> 9. <br /> 70. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to FW4-4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHtCLE <br /> [9 OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> ® UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> tAHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMNTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> ❑ TATTUO/BoDY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATK)N SITES <br /> ❑ MEDICAL WASTE rACILITY ® OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•S:DDPM (EXCLUDING HOLIDAYS) <br /> 1 . List uo to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate <br /> box(ea). At least one file type MUST be selected. Fax to (209) 4840138 or mall to the address indicated above Address <br /> ranges will not be accepted - far addltlonal assistance with file addresses, contacttho EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will no ft file applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (1D) <br /> days after receipt of application. The filaa will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on 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 flle 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 $122 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48ae * �rVksieqi Iri^2a OVA OwL Vow \NGi t`AS L M i•C- h r i • Ornalt0 <br /> s1o�p� �wwltit ,u T „� Ul$Vc (Mrs 4 e}1ay tMr.I O& of "C` �` jW4 I <br /> 0" t 1• t '.� F,(q..at' t e.NNwtI �Mllti uwlsr'Et. • <br /> 00 / 100In e XVJ 19 Lo 010Z / eL / 60 <br />