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DATE RECEf VED EHD LOG NUMBER <br /> SAN JOAOUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT" <br /> 1 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' �')� (/ ; �Iv�Telepllone: (209) 468-3420 Fax: (209) 46=t-0133 Web: :v�r�,+.s;gov.org/ehd <br /> �%�� �� `� � PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: '�� I LAS �4f1 BUSINESS/AGENCY:' f enu <br /> ADDRESS: �avv,lG�aad�o t2 C� <br /> _A CITY/STATE/"LIP: °;-�ae �z��l C Vise •��j <br /> PHONE(1):, pCt �$(�a Wit' 1 PHONE(2): 209-236- 9699 FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$130 FEE( H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSDAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street.# Street Name City [� I]Unit <br /> 2• 930 �' ci .0- `�l ® 31�y1�y ❑Unit 2 i <br /> 3. 14 6 is {AUG. V G ^ 'J*'.1 �v" <br /> 4. 1��h�1�1 Cj unit <br /> 5. <br /> El'Unit 4 <br /> 7. <br /> 8 ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit n' <br /> Specific Date Range of Information Requested: From `tp (0 to 20 l 14 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILE T YIVEHICLE <br /> C�OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®U14DERGROUND TANK(MONITORING/RENiOVAL) ❑FOOD FACILITY ❑DAIRY <br /> `©ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REwEyl: MONDAY-FRIDAY 8:00 Are-5:00Prv1(EXCLUDING 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 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.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> :3. T I;e EHO will notify thea applicant ff any EHD files exist. An appointnient for revievi will be confirmed 4pproxiniatsfy ten (10) <br /> i i atter receipt of application. The Tiles will ba held for a me Inwim of JivabusTneos days for review. Appointments <br /> siioL!Id he scheduled accordingly. <br /> ,I. Any file not returners in th)same conditlon res raleased .:ill be raorganized by EHO siafr at the expense of the applfcant. <br /> FU+.ure file reviews by the same applicant rnny r•equira a$130 deposit prior to ravie "`BOXED AREA-EHD USE ONLY"' <br /> Cl Racord:s provided by S'iai'-;SPR Cci�nplete. sta:iih�cn.: <br /> —EH D48.06 <br />