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D&TF=`RF�RVEP, EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 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 /> ow <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /�P_V 1,V VA P,00—i L 4 BUSINESS/AGENCY:- /f&/ Cce--1crL-rfj_tj <br /> ADDRESS: 24,�/ vT-Mc1,- dZvO 4-2-26 CITY/STATE/ZIP:_ 7-2,4c <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> F1 CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS,DAYS <br /> '�S <br /> SIGNATURE OF APPLICANT . 13111,3 <br /> _jZ- - DATE 7 <br /> Electronic Information: [] List D Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city 0 Unit I <br /> I 510ti <br /> 2. t m pjvr Unit 2 <br /> 3, J 131 <br /> 4. \V nit 3 <br /> 5. /A �dewS 100CA 9 Inc <br /> V <br /> 2 <br /> 3 <br /> [4 <br /> 5 <br /> 6. <br /> 0 2/unit 4 <br /> 7. <br /> 8. El Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From 4 L L to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY El SOLID WASTE FACILITYIVEH CLE <br /> M OTHER CLEANUP SITE(NON-LOP) 0 HOUSING ABATEMENT [:]WASTE TIRE <br /> VC]UNDERGROUND TANK(MONITORING/REMOVAL)S( Q FOOD FACILITY EIDAIRY <br /> F111 ABOVEGROUND TANK-- F]CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS <br /> F]MOTELIHOTEL El PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY0k,, n POOLISPA El LAND USE APPLICATION SITES <br /> ❑TATTooIBODY PIERCING [:1 COMPLAINT/RESPONSE 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-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 approkimately 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 /> I O&S Zic;Aal- rn <br /> IZ-(3: K-Ou1dleY 171 pllplilcadt of &L 4A (10 dy <br /> .; <br /> azo 7-. 0/ <br /> P/0 v,djaA 1�(mt d 1A-kl rVM7Zy,-G/n(2,sip( v a <br /> A^4 ONVZ <br /> Ellteeords-prWded- Complete:Staff Name: <br /> EHD 48-06 914112 <br />