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DATE RECEIVER, EHD LOG NUMBER <br /> 7SAN JOAQUIN COUNTY <br /> i� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Marc 66_"14 w BUSINESS/AGENCY:ke� G"Weiv.(a) <br /> ADDRESS: uu tj . keirs " . CITYISTATEJZIP:V1 SQ I ,CA � CN 61 t5 7-q <br /> PHONE('I): "5Y &ZS-,�,j 7-9 PHONE(2): FACSIMILE:_; 9S3-Z <br /> TENTATI!l PPOI�TMENT DATE: Time: <br /> PI "' <br /> 1J. 10business days from date of application submittal-*Tentative only-must be confirmed) <br /> EICHECK BOX TO EXPED TE REQU ST-$125 F E(C R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAh DATE /-Z <br /> Electronic information: EllList ElMap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# city I I <br /> Street Name 1. kwun-t I <br /> N!5(0 e0LAA-IrLel elAb �J,47 <br /> CAub 91V :;AW-_2 <br /> 2 1 &ao eoun+rtA' )-,l 25 Alkj=# <br /> P(*jP0 A13 419 j <br /> 3. <br /> 4. ElUnit 3 <br /> 5. VIII <br /> 6. V 04nit 4 <br /> 7. <br /> 8. E]Unit 5 <br /> 9. <br /> 10. ❑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 n SOLID WASTE FACILITYIVEHICLE- <br /> MOTHER CLEANUP SITE(NON-LOP) Ej HOUSING ABATEMENT E]WASTE TIRE <br /> UNDERGROUND TANK(MONITOMNGIREMOVALJ�- ❑FOOD FACILITY L1 DAIRY -,e-3/27-77-/3 <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCHJ DOG KENNEL E]WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS-4_ ❑MOTELIHOTEL [:]PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY F]POOLISPA OLAND USE APPLICATION SrFEs <br /> F1 TATTOO/BODY PIERCING El COMPLAINTIRESPONSE RECORDS [j OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ton 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 now 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 /> USE ONLY <br /> Future file reviews by the sa applicant may require a$125 deposit prior to review. : AREA�_EHID <br /> V1,17"�1 (; co IN i� a 5 <br /> )-.,,-y 64jq. A 150 rr 0 /W t,5, <br /> bi (_-Kj.5I <br /> 01.0 VU417" 6�4b Food &2L * .56 rz <br /> 13 Records prof <br /> EHD 48-06 914112 <br />