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RECEIVED <br /> DATE6ZG IVEfd Zro'jU SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �,;.%f1kLFEA(- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> IpEj*P(Tj FcV S Telephone:(209)468.3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _ /royrs /I/Jgyrvi BUSINESSIAGENCY: n/y� <br /> ADDRESS: ZsRai CITYISTATEIZIP:9IL _ ;e "ld 11A 9f3//R <br /> PHONE(1): 7(1(�_Ryf's- /533 PHONE(2): FAX OR E-MAIL: <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 reviewthe requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT --Z 00e DATE rc fjn �i/A <br /> 1. List up to ten addresses in the space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mall 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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: [?'List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From J .s to R„rsp,l <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESSFILES EHD USE ONLY <br /> GK-DEROROUND TANK(UST) Street# Street Name City 'QI211. <br /> CLEANUP SITE(LOP) 1AtIn ,A/L�CDNs.EP V <br /> r�THER CLEANUP SITE(NON-LOP) L21� 1 6A 1�1/ ,r p' <br /> �TrARDOUS WASTE JJL� LJ ��•✓✓✓tt1 „1 <br /> Dom <br /> ❑ <br /> TIERED PERMUTED FACILITY 2 <br /> �RIBCVEOROUND TANK <br /> QkJST (MONITORING/REMOVAL) ❑PWS <br /> [0JNlGRDDUS MATERV S <br /> R5.etCURE LEASE RESPONSE <br /> J7 SOLID WASTE FACILITY/VEHICLE WATEROWUry <br /> i? 4 <br /> e �FOOD FACILITY <br /> ,? <br /> POOI/SPA N SITE WROA1ro <br /> K � '�/y�LI��//1�� ///�/�1L(1� 1\n <br /> X ❑DAIRY E 1 1 `�I I`.�-C 1.1 <br /> 1 <br /> f-1 LAND USE APPLICATION SITU <br /> ❑SEPTIC PUMPER TRUCK/ <br /> fi <br /> .4 YARD/CHEMICAL TOILETS <br /> ! ❑WASTEWATER TREATMENT PLANT <br /> lif CUPA <br /> ❑HOUSING AR TEMENT T <br /> MOTEUHOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA UST <br /> 5 MEDICAL WASTE FACILITY fi <br /> y ❑TATTOOIBODY PIERCING <br /> FLy1 ❑WASTE TIRE ❑SAID WAsi <br /> 9 <br /> J �COMPLAINT <br /> F OTHER(PLEASE SPECIFY): <br /> TO <br /> •--BOXED AREA-EHD USE ONLY"' <br /> t <br /> a D Records provided by Staff-PPR Complete. sun Name: <br /> ` EHD 4846 <br /> 1 <br />