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ri <br /> DATE RECEIVED S _ i !may •J 4E � MBER <br /> VSAN JOAQUIN COUNTY � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> V _ Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION `= <br /> APPLICANT: / �G,/ �e�r� BUSINESS/AGENCY: T&�i- 2e.�r �L-t�•� <br /> ADDRESS: g/ lel/-vr-e /ice CITY/STATE/ZIP: &,K(ra-4C/S <br /> PHONE(1): q IS /Sr �S�`f PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> 19CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7-ho h;; y <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> .j o o GU. t'2 Lacer' <br /> 2.. u k - <br /> Unit'2 I 3 S <br /> c G© d S ! ��,// <br /> 4. `Lr WS -l�Yt S r d� L�'u,nit 3 <br /> 5. 2Tif'e.S C�� La <br /> - -6—---- �-- � Wl.t�.-[PJ�ta� fN-u�vY2. -— — - Kit, '-- l<!'llnit 4 <br /> 7. a. LvA s*reG <br /> 8. 6 Ko A Zq too L� <br /> ❑Units <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From 1 '20 O to _n <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ,OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA IR LAND USE APPLICATION SITES - <br /> ❑ MEDICAL WASTE FACILITY ®COMPLAINT RECORDS OTHER(PLEASE SPECIFY) sw- <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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-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 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 /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> E.r Luse orar <br /> EHD 48-06 <br /> • 811!11 <br />