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IFR EHD LOG NUMBER <br /> �";:,�, SAS! JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC O'� 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvAv.sjgov.org/ehd <br /> '%W4JIR01',PR1F7N'T L HE,',LTH <br /> PUBLIC RECORDS RELEASE APPLICATION- <br /> APPLICANT:- <br /> PPLICAl ION- <br /> APPLICANT• � �D? b El U S!IN ES S!A�G E.N1 CY: <br /> ADDRESS: ) i Lj�1� L C6 CITY/STATE/ZIP: utgHpvT <br /> PHONE (-,): S( (� $ZS Q� �7� PHONE (2): FACSIMILE: <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 REQU�-$130 FEE(CASH OP.CHECK ONLY)-REQUEST PROCESSED IN 3 6 SI SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ Map – Description: I <br /> FILE ADDRESS-- <br /> f <br /> DDRESS _ <br /> Street# Street Name City EHD USE ONLY <br /> r4. <br /> 3 g I F U C(.I D A I F I S�T _ Q I< <br /> L S <br /> OC�rt6t� ❑ Unit <br /> I i Q 0 I k ;0 <br /> f unit 2 <br /> 5. r CHIWOEL S1 �- ` 11- Oti 5 ®'Unit2H <br /> 6. I SI I N IG\3C--s?� unit 3 <br /> S7 <br /> 7. • )-C)& ti E(„ES' STOGVTbNy <br /> 8 8 <br /> q. GATION©SITE MITI <br /> _ <br /> 10. i – I CD <br /> 91 unit 5 t <br /> Specific Date Range of Information Requested: From L)►tis-( to kc S <br /> ENVIRONMENTAL HEALTH IDEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY <br /> (�, I—� Q�SOLID WASTE FACIL�IT//Y�/�VEHICLE��y� � <br /> 1,_._A,/�nT'H ER CLEA 11'UP SITE(NoN-LOP) I'�I ou CIAI/_ eHTC AI EAI iniri.C.. Ti�.`_ 1 VlJ W 1 1 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL�- ❑FOOD FACILITYV,� <br /> {,('ABOVEGROUND TANK OC ❑DAIRY F'' I z _ I-/j <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑MOTEL/HOTEL ❑PUh1PER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑�OOUSPA U LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ©COMPLAINT/RESPONSE RECORDS [.OTHER(PLEASE SPECIFY) -1 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm (EXCLUDING HOLIDAYS) ` 1 <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" <br /> I - IS ! J. CO — -Hyv -7 <br /> — je- <br /> 2-0 CJ1 lug f G f <br /> ❑ Records provided by Staff-PFR Complete. Staff Name: <br /> EHD 48-C6 <br /> 711115 <br />