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BV <br /> �+� � <br /> .. E �6 EHD LOG NUMBER <br /> E lit <br /> y` s 1/ 1,.i' SAN JC)AQUIN COUNTYRUSH <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 0 9 261(` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: {209}464-0138 Web: www.sjgov.org/ehd 9151!6 <br /> &MRC3NMEWAL I-EMTH <br /> F'I~WITMoEI:'c'I'CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 014.1- vie-&- BUSINESS/AGENCY; k'f/9 AI t7C 11155_Ue /119-T,63- <br /> ADDRESS: Q 45W4Ve ' (rWdW:' SrJIT CITY/STATFJZIP: <br /> PHONE(1): 7~ J _�;�76PCP _ PHONE (2): � i''" FACSIMILE: 9,1 6_WZ/' X7Z? <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 5nX?Q EXPEDITE REQUEST-$a3D FEE € OR CNLC4C ONLY)-REQUEST PROCESSED!rJ 3 BUSIN SS dA '4!/57 <br /> SIG ATU12E OF APPLICANT DATE 0510 /1` <br /> Electronic Information. ❑ List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ✓ ❑Unit 1 <br /> 2. I4 VJC,rt (15T� m 1.41 <br /> � f.�"l'✓ �Unit2 11vl <br /> 4. <br /> V Unit 3 <br /> U✓i�1CALAi 1 ;j lrWt,r Gtr„ <br /> WA -ids <br /> 7. i wG %�%✓ � W ' It1!Y� j <br /> $' <br /> NA lkbonits <br /> 9. <br /> 10 <br /> Specific Hate Range of Information Requested: From to (Yy I hya0 n <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES J <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(NIONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> XABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAzARDous WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00PItd (EXCLUDING HOLIDAYS) <br /> 1. List up to tan 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(2091464-0138 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 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 sante 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$130 deposit prior to review. 'BOXED AREA-EHD USE ONLY' <br /> { C c <br /> —Records provided by Staff-PPR Complete. Staff Name; 4.4 <br /> EHD4EA& +� LI �/ �/ °! )11 ✓ J Uvvl.� 1 liltt`TFI i <br />