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E D LOG NUMBER <br /> D ' � '" SAN .JOAQUIN COUNTY 46, <br /> d <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> G MAY 0 2 2 13 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4 UQM _.._Telephone:(209)468= ax <br /> 3420 F :(209)4640138 Web: Www.sjgov.orgrhd - <br /> 4 �1 ENWACI NicRfiA I IEAL;I H <br /> ICrs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r:�o r',-!2)ar y y`oro m BUSINESS/AGENCY: (AIRS <br /> ADDRESS: 6`elks 1✓� CITYISTATEIZIP: c1g0 IN / /`Is'8 3 <br /> PHONE (1): q1& 67q-ao71 PHONE (2): q16 71t-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 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S fd <br /> Electronic Information: VLIst❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street /� Street Name City ❑ Unit 1 <br /> 1 /� b A O S op +(� Ell,&_ e C 1 ' � ahw 11 f sati JG cif -f 41f ❑ Unit 2 <br /> 3. <br /> 4' X'j— v IL Unit 3 <br /> 5. Pr ArnzpcLf/ 1 Q19 L <br /> 6• r I4 <br /> 7. <br /> B. �i - 170�� <br /> ❑ Unit5 <br /> 9. 51 � <br /> 10. Zq(a.0 ❑Unit s <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 FACILIT /VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUNDTANK E]CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATR IENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD CHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATIC N SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPEC FY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDI 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 theappropriate <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 appli ation 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 (4s-r C d r U ' i r fk <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 914112 <br />