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P 9A 19 D a� <br /> DATE RECEIVED Mt '°N Mu,: H �[R 'Z a DT I <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> DEC 0 2 ZO'ielephone: (209)468-3420 Fax: (209) 464-0138 Web: www-sjgov.org/ehd <br /> tVIRON!19�EN0,LHI: ITF <br /> EALI PUBLIC RECORDS RELEASE APPLICATION <br /> � <br /> APPLICANT: BUSINESS/AGENCY:\2l9AJQaAutfi 04ij LWLW6� <br /> ADDRESS: gl042-ZI'14�" t)ke- CITY/STATE/ZIP: �% 0 <br /> PHONE (1): 41 PHONE(2): FACS1MlLE:_UQf0_�_�qql� <br /> Please alloW 10 business days from date of application submittal for the records to be available, <br /> Staff will contact you to a r n a an appointment date and time to review the requested records, <br /> ❑ CHECK BOX TO EXPEDITE R F<Qj OR HECK ONLY)-REQUEST PROCESSED IN 313USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_L?J, S I (q <br /> Electronic information: List[D �L bescript6k <br /> Y. <br /> FILE ADDRESS f EHD USE ONLY <br /> Street# Street Name city <br /> El Unit I <br /> &,4 D <br /> 2. <br /> L3 Unit 2 <br /> 3- PALL <br /> 4. <br /> .kx>hjq I ca m,_4 It 30 <br /> Unit4 <br /> 7. Jri <br /> 8. /Unj <br /> 9. <br /> 10.110. 1 [2-units <br /> Specific Date Range of Information Requested, From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IUNDERGROUND TANK(UST)CLEANUP SITE(LOP) EIMEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHic.LE <br /> OTHER CLEANUP SITE(NON-LOP) K)HOUSING ABATEMENT WASTE TIREJ Ufi <br /> UNDERGROUND TANK(MONITORINoIREMOVAL),,,-/ ❑FOOD FACILITY DAIRY <br /> ABOVEGROUND TANK ci- tgCHICKEN RANCH/DOG KENNEL ASTEWATER TREATMENT PLANT 11Z-1 S <br /> HAZARDOUS WASTEMAZAkDOUS MATERIALS A '0 MOTELIHOTFL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPALAND USE APPLICATION SITES <br /> ❑ R" <br /> TATTOO/BODY PIERCING _5aCOMPLAINT/RESPONSE RECORDS Lj THEIR(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 15:00 Am-5:00pm(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(209)464-0138 or mail to the address Indicated above- Address <br /> ranges will not be accepted.Applications received after 3"00 pm will be processed the next business day. <br /> 2. For assistance In Identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3- 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. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will bo reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant/may require a$130 deposit prior to review. '"BOXED AREA -EHD USE ONLY"� <br /> br <br /> -(5; ., UEIJ I)AP5 iyf j bk 0,-Oh?e__15eLh �iA <br /> fX,2j <br /> 3 q�Z(jLvtk-, <br /> 42, <br /> &0 Lbo�i Ilog r4t czlcyo , Qi)Ilq _6 L,11 Xq't 0 <br /> J, n <br /> _j <br /> EHD 4a-m t�A h(P, �or tojA�,(jai <br /> eA V jaAca_ Ir 1- IZ-15 &LAkVq-7Lqj 081011U, <br /> L7fA I A7 7 <br />