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DATE RECEIVED EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY <br /> REG'D DEC .� 7 2O�n ENVIRONMENTAL HEALTH DEPARTMENT <br /> r 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ` <br /> U57 wJ"` Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: %V"j.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; (, L�!(, (��-/ �� h BUSINESS/AGENCY:( C eiyl.(G(C% 6/ Li <br /> � j �' `{,IC�, i 1& CITY/STATE/ZIP: n 6VL; N L' <br /> ADDRESS: � t;);`" r LL1L c �� <br /> PHONE (1): C�sj ZI(4 ' L,�' PHONE (2): FACSIMILE: <br /> GL-l v 5� & 6�'>(CL).%;J,,t LT/,4-L. C6)'1 <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-S130 I E(CASH{JR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT �? :� DATE— 2 Z� <br /> Electronic Information: [] List[] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 100 (Al. UYWO <br /> 2. �— '�t7" ' ❑Unit 2 <br /> 4. Q Unit 3 <br /> 5. f <br /> 6. I , 'L7i T -- O Unit <br /> 7. <br /> 8. + ❑Unit 5 <br /> 10. ❑Unit G <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ASATE14ENT ❑WASTE TIRE <br /> ❑C UNDERGROUND TANK(MONITORINGIRELiOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREAT htENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUSMATERIALS ❑MOTELIHOTEL []PUf,{PER TRUCKIYARDICHOucAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COh1PLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: 110ONDAY-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.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. 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 riles will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will b^reorganized by EHD staff at the expense of the zpplicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. "'BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. srff <br />