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Ulm/U^l/ GVl.I +�••+� +--�+•+ +vra... <br /> S 1 <br /> oERECENED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> —ENVIRONMENTAL HEALTH DEPARTMENT SGO4 1868;East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �,pY? r/ ji /�—, _ BUSINESSIAGENCY; <br /> ADDRESS: _ /GG �'y LSC /// tir i /)lC, ` CITY/STATE/zip: /4�l4,rD C0/0a,//4 G�- <br /> PHONE(1): /�i. ��.��/G PHONE (2):—VC ,57, //F�/ FAGSIM+LE: _7_412 <br /> ��I6//Z� -r�DCoN•"tiv� GQ/•r <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK FOX TO EXPEDITE REQUEST-$1�3.GFf�Q,QSH-OR'MHEGK ONLY)-REQUEST PROGE&SED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / r e DATE <br /> Electronic Information: ❑ Llst p—De riptlon: <br /> FILE ADDRESSEHD USE ONLY <br /> Strao[iR Street Name – City ❑Unlit <br /> 2. _ � 3doa3.. la unit2 <br /> J II <br /> 3. . t <br /> 4. <br /> EfUn It a <br /> 7. <br /> 0 Unit <br /> 10. —' — unit <br /> SpnclRe Oatn Rnnge of hltormaNnn Roquasted: From to <br /> ENVIRONMENTAL—HEALTH DEPARTMENT FILES pp 1 <br /> ONDERGRouw TANK(UST)CLEANUP SITE(LOP) L7MEDICAL WASTE FACILnu Y SOLID WASTE FACILnYivEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WAsIETiRE - . <br /> UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK U CHICKEN RANCH/DOC KENNEL ❑WASTEWATER TREATMENT PLANT <br /> jj�.(f AZARDOUSWAST@/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SD'ES <br /> ❑TATTOOISODY PIERCING ❑COMPLAINTIRESPDNSE RECORDS ❑OTHER(PLEASE SPECIPY) <br /> L AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5;DOPM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten add resses.In the Space abovP. SPlectth typc(s)vfifNs�s from the list above by checking the appropriate <br /> box(es). At.least one file typo MUST be selected. Eq to(209)464.0130 r mail to thea dress indicated above. Address <br /> ranges will not be accepted,4ppllcations recerrod next business day. <br /> 2. For assistance In Identifying the nature and content of FHD 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 atter receipt of application. The files will behold for A maximum of five business days for review. Appointments <br /> should be scheduled accordingly. - <br /> 4. Any filo not returned in the same condition as roleased will be roorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. ­BOXED AREA-EHD USE ONLY*" <br /> ❑ Records provided by Staff-PPR Complete.staff name: a <br /> azm�a <br /> eHD 4a•On ' <br /> Received Time Jan. 7. 2015 2:43PM No- 7851 <br />