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& <br /> DATE RECEIVEDEHD LOG NUMBER <br /> 001 ' <br /> �� � SAN �1OAQU1�J COUNTY <br /> - ENVIRONMENTAL HEALTH DEPARTMENT (t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd ' u <br /> - PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l/vsleh 1211n11 BUSINESS/AGENCY: pwj ,c,hm. <br /> ADDRESS: 3{oct lbue�tat glvai Ste: 7a� CITY/STATEIZIP:_ Recc«It, rA K66t <br /> PHONE(1): eL� q,.(s-- =-I-t$ PHONE(2): �Zz�� yg t-3'tVto FACSIMILE:t dA <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-$1130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> T6o <br /> /Street Name City <br /> ut{rCaV VA t corp14 IA CBS I]'Unit2;W �1) Nocnoppp FSS Hvr r S� '10StJ"Unit3 <br /> t 5. tort S AS .MPcrsp .\) <br /> 6. �✓ <br /> TA D nit4 6y, <br /> 7. <br /> 8. <br /> 9 ❑Unit 5 <br /> 10. <br /> i <br /> Q'Unit s <br /> Specific Date Range of Information Requested: From I`lm to <br /> �,,� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L�7,�U(NDERGROUND TANK(U SITE(LOP) DVEDICAL WASTE FACILITY BSOLID WASTE FACILITYIVEHICLE vV <br /> ryL7UTHER CLEANUP SRE(NON-LOP) ❑HOUSING ABATEMENT �ASTE TIRE I <br /> L�'J"��U/NDERGROUND TANK(MONITORING/REMOVAL) ❑,�,�F OD FACILITY 2-15AiRY 1 3 y <br /> E2<00VEGROUND TANK D HICKEN RANCH/DOG KENNEL U 7, <br /> [ - AAZARDOUS WASTEIHA7ARDOUS MATERIALS I9'WASTER TRUCKREATMEHEMICAT IL- <br /> r❑yM�OTEL/HOTEL [9-PUMPER TRUCKIYARD(CHEMIGALTOILETS <br /> I�TIERED PERmnTED FACILITY L� OOLISPA [a'CAND USE APPLICATION SMEs <br /> ❑TATTOOIBODY PIERCING [aJCOMPLAINTIREsPON5E RECORDS [�'IJTHER(PLEASE SPECIFY) it�%eG <br /> EaIIDAYS <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B;00 AM-5:OOPM(EXCLUDING HOLIDAYS) ----S%" <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 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$130 deposit prior to review. "*BOXED AREA-EHD USE ONLY'"` j <br /> •z�'i� �r•`s -] iay7`7 , il�ltn 11� . To � � . .0 i HvJ lE- i <br /> - eons cc3u�Lx- z2 w� 2�1�1�1 � I T: r -,Y,.6i3t <br /> r( i- <br /> OLI kq IAJ P7,4&1 cl ; f f- f s XS3.0o1 74 ss of -t Si onL. 15�- 10 10 141 usfnt j <br /> ,icl�I/-Q ' _ds c :r5J cz4l9A$j X�nyo17, xC'SO401 (=C,- IDZI 1,jdash-lat <br /> Emu 48-06 XSJo/Ip'7D Fo." 7W i}11/c! /'rCtl �`rz;rldkc( ulk4 Jc_:t IJP ,�� [1 Ind 08101119 �. <br /> inadritrpr XS�aii/3 , SO us}-rtuL� <br /> io2i 'no(u,56-1 li (Ingedion Inc d Cern Rufuets) t 10,51 merry ftilctv,&k Cid of 74;o I�adgsfiycL(-aSTf=jam <br /> q5o ;rtciustrluN uSr Hie t ioS} Sp" ASF fel,+ tutu.. ic+ Tlrs. lt�A lejkb For' 74ro IndUt-"-1rj dLQ_fz> 3 <br /> �,.,t- <br />