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12 <br />0 c(0)PY <br />DAT E RECEIVED , EHD LOG NUMBER <br />SAN JOAQUIN COU14TY <br />�7 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: l 1 o G eiq - q BUSINESS/AGENCY: f ('j A <br />ADDRESS: QZ t a2 LCCy LA)0i CITYISTATEIZIFs; ��(� �, j q ZZM <br />PHONE (1). �f-P­17-0(o&!1 PRONE (2): 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 $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT. zrc�� t.iiDATE <br />Electronic Information: ❑ List ❑ Map -• DescriptiorY`' <br />FILE ADDRESS <br />Street# Street Name City <br />EHD USE ONLY <br />(T1 Unit 4 <br />1. <br />Jtt� <br />"'= t...-1 <br />,0 Unit 2 <br />L/1 Unit 3 <br />2. <br />3. <br />if _'.s'__'•' ifi.4��T .i' �.. Y <br />4. <br />__ ;- f�'f� , <br />5. <br />t` Li <br />�'i t' <br />ti's ►.iv c C: �,� <br />N7T Cc'S�J <br />IZI Unit <br />6.fjMM <br />tt -� <br />r 9Iq <br />Hu M <br />'�� <br />o Unit 6 <br />a C }- f <br />-- �, <br />9. <br />`i� 2-0 <br />fJ . t x7cxz � <br />N1J� SCC S� <br />[K] unit 6 <br />10. <br />�r­ -HW Ve uuvw1auou mequestea. rrom to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES c) <br />K UNDERGROUND TANK (UST) CLEANUP SITE (LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE �,2 I <br />CA OTHER CLEANUP SITE (NON -LOP) A HOUSING ABATEMENT ❑WASTE TIRE f CD <br />[„UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY DAIRY vlyni� a <br />Q ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUs MATERIALS ❑ MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br />[� TIERED PERMITTED FACILITY ❑ POOLISPA LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING "(may COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <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. Applications received after 3:00 pm will beprocessed 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 files 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 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. ***BOXED AREA - EHD USE ONLY'* <br />4;r t tGJl. a v <br />GiL 1 IJ 1 i✓1 U -6 0 C[rb `vi l� � 1u✓I7�it i ��� 4/28N4 <br />101- <br />= OZO(oL+ <br />Jtt� <br />17 17- IV <br />cl CD <br />0 f <br />-F <br />T 67 so -1- e/Aja ' <br />�J 1MV1 fU/1 <br />(� 1 <br />r 9Iq <br />Hu M <br />dct� <br />f'vJ <br />a C }- f <br />Lcb- 531 1 <br />E14D 4MS <br />q1.tnkI . aQ�1 <br />—n _ L T <br />©,� <br />(' f)1; ZLI'U`bl <br />5i� f rl g lihj#14eA <br />ZD <br />GiL 1 IJ 1 i✓1 U -6 0 C[rb `vi l� � 1u✓I7�it i ��� 4/28N4 <br />101- <br />= OZO(oL+ <br />