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F� DATE RECEIVEDEHD �IOAQUIN COUNTY EHD LOG NUMBER NR ENVIRONMENTAL HEALTH DEPARTMENT RFC'D DEC s U l 1868 East Hazelton Avenue, Stockton, CA 95205-6232 1 hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 7qq3l @ BLIC RECORDS RELEASE APPLICATION APPLICANT: ADDRESS: PHONE (1): Please allow 10 b Staff will contact ❑ CHECK BOX 1.0 EXPEC SIGNATURE OF APPLICA Electronic Inforr 62 Str©et # 2 7 3. 'Z 7 Z. 4. q Stara 5. 7. d D 8. 9. 10. PHONE (2):: BUS[ NESS/AG ENCY:SQ./Z-1j6a clt'4 6- , �ieb`iCleb CITY/STATE/ZIP:,� SZ0S _ FACSIMILE:70�) (.0 P -ag 1 J tress days from date of application submittal for the records tip be available. u to arrange an appointment date and time to review the requested records. E RE - 5130 $130WHECK O HECK ONLY) -REQUEST PROCESSED IN 3 BUSIIJESS DAYS T DATE rsaki®n: 2fist ❑ — Descript n: 1LE ADDRESS EHD LISP ONLY Street Name City - t r4unit 1 S. S.baow r2_0 77 � m M,- , ?( �1 I �7 Z1�IJLvI Unit2 S - c -A wAL. Ho S. ®L 1.nw f2-o0 Unit$ �S GvL uc�w a 2 >r�� iLl7 1�� L�?n P IL D Unit S LTC eo p K 0rUnit 5 it F1 UnIQ 6 Specific Date Range of Information equ "ed: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE OTHER CLEANUP SITE (NON.LOP) HOUSING ABATEMENT WASTE TIRE Y IPS, I CD rO/- UNDERGROUND TANK (MONITORINGI EMOVALb�_ FOOD FACILITY DAIRY LAA .1 3 - /- I? -) j ABOVE®ROUND TANK c < ECHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT HAZARDOUS WASTE/HAZARDOUS W TERIALS ® MOTELIHOTEL rA PUMPER TRUCKIYARDICHEMICAL TOILETS TIERED PERMITTED FACILITY Cx, ® POOUSPA LAND USE APPLICATION SITES F] TATTOO/BODY PIERCING l��i COMPLAINTIRESPONSE RECORDS OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT REC RDS ARE AVAILA13LE FOR REVIEW: MONDAY-FPJDAY 8:00 Am-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses int the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file typ 5 MUST be selected. )Ejax to (209) 494-0138 or mail to the address indicated abova_ Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifyinc the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the appli ant if any EHD tiles exist. An appointment for review will be confirmed approximately ten (10) days after recelpt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accord ngly. 4. Any file not returned in the sme condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the satne applicant may require a $130 deposit prior to review. —E30 (ED AREA - EHD USE QNI-Y' i El Records provided by Skff-PPR Complete. staff Name: END 49-06 00101/14 Received Time Dec. 18, 2014 3.:36PM No.7748 Specific Date Range of Information equ "ed: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE OTHER CLEANUP SITE (NON.LOP) HOUSING ABATEMENT WASTE TIRE Y IPS, I CD rO/- UNDERGROUND TANK (MONITORINGI EMOVALb�_ FOOD FACILITY DAIRY LAA .1 3 - /- I? -) j ABOVE®ROUND TANK c < ECHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT HAZARDOUS WASTE/HAZARDOUS W TERIALS ® MOTELIHOTEL rA PUMPER TRUCKIYARDICHEMICAL TOILETS TIERED PERMITTED FACILITY Cx, ® POOUSPA LAND USE APPLICATION SITES F] TATTOO/BODY PIERCING l��i COMPLAINTIRESPONSE RECORDS OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT REC RDS ARE AVAILA13LE FOR REVIEW: MONDAY-FPJDAY 8:00 Am-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses int the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file typ 5 MUST be selected. )Ejax to (209) 494-0138 or mail to the address indicated abova_ Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifyinc the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the appli ant if any EHD tiles exist. An appointment for review will be confirmed approximately ten (10) days after recelpt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accord ngly. 4. Any file not returned in the sme condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the satne applicant may require a $130 deposit prior to review. —E30 (ED AREA - EHD USE QNI-Y' i El Records provided by Skff-PPR Complete. staff Name: END 49-06 00101/14 Received Time Dec. 18, 2014 3.:36PM No.7748 1. List up to ten addresses int the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file typ 5 MUST be selected. )Ejax to (209) 494-0138 or mail to the address indicated abova_ Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifyinc the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the appli ant if any EHD tiles exist. An appointment for review will be confirmed approximately ten (10) days after recelpt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accord ngly. 4. Any file not returned in the sme condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the satne applicant may require a $130 deposit prior to review. —E30 (ED AREA - EHD USE QNI-Y' i El Records provided by Skff-PPR Complete. staff Name: END 49-06 00101/14 Received Time Dec. 18, 2014 3.:36PM No.7748