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EHD LOG NUMBER <br /> 6 R. EtVED #:�/ OAQUIN COUNTY <br /> '11 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 Eas[ Hazelton Avenue, Stockton, CA 95205-6232 <br /> r2 �t�O ,tE'i'I� {ML �f4ephar�e: (209) 468-3420 Fax: (209) 464-0138 Web-, www.sjgov.org/ehd <br /> trPUBLIC RECORDS RELEASE APPLICATION—1- <br /> � IJa�rr✓'fw•,_ <br /> V <br /> f I-•4" I U,r <br /> PPLICANT. = <br /> �s v1 v .� . victoria \! BUSINESSIAGENCY'Kteinfelder <br /> A <br /> ADDRESS: 2001 Arch Airport Rd. Suite 100 CITY/STATEILIP: Stockton,CA 95206 <br /> PHONE (1): (209)469-4375 PHONE(2): (209)948-1345 FACSIMILE: (209)234-4700 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> {Pt�ease allow 10-business days rom date of ap Ircation submittal-`Tenfative.00n-must be cc'onfirrned) �� Y " To <br /> �- !,� <br /> f CH BOX'T�PEDIT EQ E $1 k {CASH O�ChiECK ONL�)�REQUEST PROCESSED IN'3-BUSIN\PSS DP�,Y! �? <br /> �..r Ci <br /> SIGNATURE I�PLICANT_4 ,'�;,v; ,a– DATE / - leK /y All <br /> Electronic Information: ® List L] Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 1 Street Name City ❑Unit 1 <br /> �j IYr Z��� t1 ❑Unit2 <br /> r3-4 <br /> -7I--��r4)Cc) rrm 2153-2--l-5-2, Q `` Unit 3 <br /> r!� 7 <br /> 6. <br /> aLl <br /> Utt 4 <br /> 13. <br /> / ; ❑Unit 5(glue <br /> Li 3 S2$ (f I, i h pdnit 6 <br /> Specific Date"Range of Information equested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> — <br /> 91 UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY X❑SOLED WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(Nom-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL. ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS'NASTEIHAZARDOUS UATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ©TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINVRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 Am-5:00Pnrl(EXCLUDING HOLIDAYS) <br /> 1. List up to fen 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 EFID staff may not be immediately available for review. A new application may be <br /> submitted:•Then the file is available. <br /> 4. Any file not returned in the same condition as released will be reorga sized by EHD staff at the expense of the applicant. <br /> Future fife revie:vs by the same applicant may require a$125 deposit prior to revievr. "*BOXED AREA-EHD USE ONLY <br /> ❑ Records provided 13y Si.<tfC-PPR Coni Clete. staff riantie: <br /> EHD 48-DG <br /> 974!1 Z <br />