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SAN JQAQUIRECEIVE&lronmental Health department <br /> l�ria T v PUBLIC RECORDS RELEASE APPLICATION <br /> MAR 2 S BY EMAIL 0�J' I <br /> _ EiHD LOG NUMBER: <br /> • APPLICANT: fits -. .,. _,_ �USINESSIAGENCY;>> 1 -•. <br /> ADDRESS: 27V;174 a. ;+.: CITYISTATEIZIP: l L+Jla3 <br /> PHONE ii): 85U115J7S. PHONE(2): _ FAX OR E-MAIL: :>.+u'ta¢:7znaonmeraLmm <br /> Please allow 10 business days tom d to of application submittal for the records to be available. <br /> Staff will contactYf to 'ra e a ppointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT "� _ DATE <br /> 1. List up to ten addresses In the space below. A dress ranges WILL NOT be accepted. Select the typists)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)484.0138•mail to the <br /> address indicated helow,or email to infek5slcehd.com. Applications received aftor 3:00 pm will be processed the next <br /> business day. <br /> 2- For assistance in identifying the nature and content of END records,please contact END at the number noted below. <br /> 3. The ENO 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 /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. i j ✓_ <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. `L D <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: 0 List❑Map–Description: <br /> Specific Date Range of Information Requested: From to _ <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT E H D USE ONLY <br /> FILES (SpGe15c iwresses anly. address fangos will not be.N.CZpiAdj <br /> ❑x UM:Iogrona Tari iVsTI streot# _ Street NameCity ._ <br /> C19MOa Snn i1 c=' Gxr°qr° <br /> �ii]Caer l;+yruP Z.l\=rrLOP; � 3440 East Main Street Stockton <br /> 0Il.e,x�lws'hasie L - - - -- ❑-J.K• <br /> ❑iwmr P,;oes Fe01.1y ' <br /> �]x onuvarjal.Me T.lne �ST,`-�IP _ _. _ _ <br /> ©UST (M.=rIM'4tor1:n11 0 <br /> ©H0.tHVLrs Malerds ; <br /> Q S m n r <br /> ElSAa <br /> El <br /> ❑Oa?r s <br /> taMa'uc1 Ap01:-Caliv-&'1_r.: <br /> Yam.''-3Mcmry 7.1, <br /> I]'A'aE1Cm0frs Trealersnl mwm I CUPl. <br /> nousr'a ArMc-cn1 r A£.T +M KN <br /> I]Mmn'I lmrl <br /> B JE- <br /> Mnu ul Y.'aslt ryainy <br /> T:rtan•Bnh <br /> rj wAer Tim l _-- <br /> Y I <br /> co–t-41I —BOXED AREA-END USE ONLY... <br /> , '�,- A N 24' RRA, {�.�eP �slat�,.1nX - ' _ ilc ✓�bv <br /> ❑ Records provided by Staff-PPR Complete. 5to Nama. Ell:,,:.16 <br /> `• 1868 E, Hazelicn Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 464.913: 1 :;v•,: s rehd com <br />