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DATE RECEIVED l FME COPYHD LOG NUMBER <br /> SAN J AQ IN OGNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �0 ephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> qlqlfi <br /> (� +PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: D"It IJ131� BUSINESS/AGENCY: kfA-'S� <br /> ADDRESS: b�f�2«-��Q2 CITY/STATE/ZIP: <br /> PHONE(1): PHONE(2): `)a�0 —9,a 3'C)f 5- FACSIMILE: E"�—C.33 —O)f 7 <br /> I l l TENTATIVE*APPOINTMENT DATE: /�3 x R 5 r r�Q4 Time: <br /> (Please allow 10 business days from date of applicat of ii submi I-*Tentative only-must be confirmed) <br /> �I�CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGGN—ATURE OF APPLICANT'y S k)1' �` (.L6 f� % 7, DATE <br /> Electronic Information: ❑ List❑Map–Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> L I Ckoftr <br /> ,, /n► � i� j r <br /> VO (Nn- <br /> Q Unit 2 <br /> *3. Sh7cAr <br /> �� <br /> i <br /> 4, pJ Unit 3 <br /> 5. —SILL �, 1 <br /> 6. ©Unit <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. V Vol 13 ;RJ Unit s <br /> Specific Date Range of Information Requested: From to j <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> %NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ESOLID WASTE FACILnYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WTWASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOYAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/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 J;COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEw: MONDAY-FRIDAY 8:00 AM-5:OOPM(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. '*BOXED AREA-EHD USE ONLY <br /> El Records provided by Staff-PPR Complete.staff Name: <br /> EHD 48-06 914/12 <br />