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IV <br />Iv., iE SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />APR 01 Stockton, CA <br />1868 East32 <br />--.-Hazelton—,-ono.vaha n138 Web5www•sj90 <br />Ii tllTl� <br />csl oPtI Ir RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />Bock and Clarx <br />Gayle Gordon Lyons, CO 60540 <br />APPLICANT: Y CITYISTATEIZIP: <br />ggordon®bockandcl ark. Com <br />ADDRESS: 55 Longmont Dam Road � FA}( OR E-MAIL: <br />PHONE( 303-823-0132 PHONE(2): <br />Please allow 10 business days from dat ointment date and oi al) t mle to reviewtherequested records. <br />Staff will contact you to arrange an app <br />❑ CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED N 3 BUSINESS DAY <br />TE <br />SIGNATURE OF APPLICANT <br />List ❑ Map - L7escnpu-,,. <br />Electronic information: ❑ EHD USE ONLY <br />FILE ADDRESS <br />City <br />Street # Street Name <br />nit 1 <br />1. 5100 N. Highway 99 Frontage Road <br />Stockton 21'z� , PI�3bortS� <br />2. (3) tpD7-1`9"` - PK03 1 rr VV✓i t [�Tjnit2 <br />s. <br />5104oV3 Lake M�+le � otl 4 IZ <br />51 Unit 2H <br />4. P/UnIt 3 <br />- 5 d1jnit3HM <br />6 ❑ unit 4 <br />i <br />7. <br />p 6 ❑ Units <br />10. to <br />Specitic Data Range of Information Requested: FromENVIRONMENTAL HEALTH DEPARTMENT FILES ❑ SOLID WASTE FACILITYNEHICLE <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) EjMOTELIHOTEL ❑ FOOD FACILITY <br />HOUSING ABATEMENT ® DAIRY, POOLISPA <br />® OTHER CLEANUP SITE (NON -LOP)[] WASTE TIRE <br />® UNDERGROUND TANK (MONITORINGIREMOVAL) E] CHICKEN RA WASTEWATER TREATMENT PLANT <br />DOG KENNEL <br />® ABOVEGROUND TANK E] MEDICAL WASTESTE PUMPER TRUCKIYARDICHEMICAL TOILETS FACILITY LAND USE APPLICATION SITES <br />® HAZARDOUS WASTE ❑ TATTOOIBODY PIERCING OTHER(PLEASE SPECIFY)111ega1 Drug Ld <br />rBy ® HAZARDOUS MATERIALS <br />COMPLAINTIRESPONSE RECORDS <br />rop ❑ TIERED PERMITTED FACILITY <br />DCI WELL AND SEPTIC PERMIT RECORDS AREAVAILABLE FOR REVIEW: <br />s of files froim the 010 tabove by check ng thM (EXCLUDING e appropriate <br />Lc 1, List u to ten addresses in the space above. Select the type(s) (91 )q 8 or mail to the addr <br />>D<_ box(es). At least one file type MUST ationselected. <br />lecteved after 00 pm6w'�011 be processed the next business day.bove. Address <br />ranges will not be accepted. App <br />ointment for review will be confirmed approximaelyto(10) <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 app <br />days after receipt of application. The files will be held for a maximum of five business days for review•Appointmentsapplicant. <br />should be scheduled accordingly. <br />4. Any file not returned in the same condition <br />may release a $130 deposal prior to byrev D,Asrtaff at the expense of the app <br />Future file reviews by the same app' OXED AREA • EHD USE ONLY` <br />Staff Name: <br />