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D - C_4) Ef ,H Ff.Y.=, - EH LOG NUMBER <br /> ➢ Ei 1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAY () 2 2 13 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��v4►n — �4to <br /> -T61t phone:(209)4ax <br /> 68--3420-F :(209)464= b:0138 Wdwww.sjgov.org/ehd - -- - - <br /> ENUR(NMFNTAI CALL H <br /> PEI=-MY1:r .3!10ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C) r(-Q)o r v K0 CO Se BUSINESS/AGENCY: S s <br /> ADDRESS: DF�Q &q.' 1Ccy ��VS ()r SfrJ-f 0 CITYISTATE/ZIP: CI"Pn ! -003 <br /> PHONE (1): % 67q--J 0.71 PHONE (2): % 7/8--6.Tg7 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 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: VList❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City ❑ Unit 1 <br /> 1• 70,0 IZOA 00 <br /> 2. tJ��7' -04'67sf r k, ,N, OetVf C+< { df ❑ Unit 2 <br /> 3. <br /> 4. 1 0f' ►J(7 - / Unit 3 <br /> 5. Pr u LC/ 1 Q�l q <br /> 6. / IF ❑ nIt 4 I \ <br /> 7. (�jb <br /> 8. $'i - 17P <br /> ❑Unit 5 <br /> 9. bF. rpm <br /> 10. _`oz- 4f 1 29 6 O ❑ Unit B <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY EHICUE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATERTREATM NT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDI HEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATIO SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECT Y) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDIIN G 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 ap propriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address indicated abo . 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. Appo ntments <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. "*"BOXED AREA-EH13 USE ONLY"* <br /> a- <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHO 46-D6 914112 <br />