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s <br /> V MINNTY <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JI AQ <br /> t l I v I( ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Gqll�hone: (209)468-3420 Fax: (209)464 0138 Web: www.sjgov.org/ehd <br /> pp Q PUBLIC RECORDS RELEASE APPLICAT101 <br /> APPLICANT: D"It WIC BUSINESS/AGENCY: 160C4le-3 <br /> ADDRESS: CITY/STATE/ZIP: 1t���,( c/f <br /> PHONE(1): PHONE(2): J`3O FACSIMILE: X"--G33 ^O)J7 <br /> /I( TENTATIVE`APPOINTMENT DATE: A 5; „ ml/e blc Time: <br /> / 'f (Please allow 10 business days from date of application submi I-'Tentative only-must be confirmed) <br /> f <br /> "LJ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-RECIPEST PROCESSED IN 3 BUSINESS DAYS <br /> t <br /> IGGGN URE OF APPLICANT—o \,t — t L6 } L//G Z 7 DATE <br /> Electronic information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. QqqlW {Zwr' Q G <br /> 2• 1 Ryt Cq,r,r G' ❑Unit 2 <br /> 3. _&d_q <br /> 4. � /u it <br /> 7. <br /> 8. S+V=i ❑Unit 5 <br /> 9. / <br /> 10. F7 Unit e <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES YX <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) [—]MEDICAL WASTE FACILITY 2 SOLID WASTE FAciuryNEHICLE <br /> OTHER CLEANUP SITE(Nom-LOP) E]HOUSING ABATEMENT �HASTETIRE <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> [KHAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑.TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOoBODY PIERCING ;RCOMPLAINTIRESPONSE 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 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-for additional assistance with file addresses,contact the 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. 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 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 applicant may require a$125 deposit prior to review. " BOXEO AREA-EHD USE ONLY <br /> ❑ Records provided by Staff-PPR Complete. Safi Name: <br /> EHD 48-06 W4112 <br />