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D � q HD LOG NUMBER <br /> m . <br /> SAN JOAQUIN COUNTY <br /> ,61 ENVIRONMENTAL HEALTH DEPARTMENT <br /> .75 <br /> MAY 0 2 2 13 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> v41n - -Telept�rie:(209)468--3420-FaX:-(209)464=0138 Web: www.sjgov.org/ehd- - - <br /> ENViRC)NMGNTAI HEA_rfH <br /> P tfi l3" .•1iCrS <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Gr(-Q)crV KOrOSe- BUSINESS/AGENCY: L49S A <br /> ADDRESS: D FWI&Ctle&tay OGkS' of : Swl-I 0_aPJ CITY/STATE/ZIP: C)C1r) rd <br /> PHONE (1): q1& 67q__4: 0-71 PHONE (2): q16 71e-63N7 FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of.application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN HESS DAYS <br /> SIGNATURE OF APPLICANT DATE SX <br /> Electronic Information: List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONL <br /> Street Street Name ��•• City El Unit 1 <br /> 1. o R o b� OQ 410K/ rrC . <br /> 2. DLA - e reur Oetvf s4. o -Act"p< .lt <br /> ❑Unit 2 <br /> 3. ", S <br /> f o <br /> 4. 0 !rj— /foe_ <br /> Unit 3 <br /> 5. °r s Lclee c qF-c l�S �DfeRr, I <br /> 6 r [216n it 4 I� <br /> 7. (% <br /> s.. �i - �P <br /> El Unit 5 <br /> 9. <br /> 10. 2-9LICq 29(v 0 ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY -1 SOLID WASTE FACIL (VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT [I WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATERTREAT ENT PLANT <br /> HAZARDOUS WASTEIHAZARDOuSMATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYAR /CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPEC IFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUD NG HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking thea propriate <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 /> shodid 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, "*"BOXED AREA.E D USE ONLY* <br /> r [AS-r C d r V (fv r fk l r c <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4"S <br /> 914112 <br />