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RECEIVE <br /> DATE�y��E <br /> ra't/lr P 0 20% I) f /to SAN JOAQUIN COUNT EHD LOG NUMBER <br /> ENVIRQNAfEpTAL HEgLTH VIRONMENTAL HEALTH DEPA 9520 8503 r <br /> PE-RMIRSER 1:(2 East Hazelton Avenue, Stockton, CA b: -6232 `J <br /> VICES Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.Sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �g ''E BUSINESS/AGENCY: <br /> ADDRESS: J g p Q(-Ip 1„I iti i r- 'S S t 3 zo CITY/STATE/ZIP: S�c C1a 3 SS 3¢- <br /> PHONE <br /> t'Y7 IGLIli2I. 2nt�P_rful� <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 /> - E xl}-,GIXTd B➢CP D Et2EolllEs' '$7a�,FEt cASH.%`S'R ci{F l�,'bFiL l�t� rte© Es5Eb Ti`.3 . .. <br /> SIGNATURE to APPLICANT Atiu ���� DATE //// o,/ 6 <br /> 1. List up to ten addresses m the space b ow Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file Type MUST be elected. Fax to(2091464.0138 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$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: EaLISt❑ Map-Description: i'�j G de„+-c <br /> Specific Date Range of Information Requested: From q 9 0 to re f <br /> 260 K' <br /> ,pAR?M�T FILE ADDRESS <br /> PIKES EHD USE ONLY <br /> UNDERGROUND TANK(UST) 70S, <br /> treet Name City /� <br /> �LEANUP SRE(LOP) _/, ° xsurnea <br /> mER CLEANUP SITE(NON-LOP) ' 1306010 (r"al qO��ob� �/--Q G_ ,r!ANDU'5I(.�LJ� <br /> DOUS WASTE <br /> VER EO <br /> PERMITTED TFDPaDILIT/ 2 f Tal H�I��N, RUaa rd c GA GOJEGROUNO TANK ,T ( 1 �(�(/t5TMONRORINO I RENOVIwL7/' NONoc0(�! °PW5 <br /> AIARDousMARULs3 3rral ffblldw <br /> GPILL/RELEASE RESPONSE <br /> SOLD WASTE FAC KL /VEICLE 4 t, y, tII, I N WATER OU-- <br /> M FOOD FAz:uw v <br /> (]POOL/SPA STE MITNATION <br /> ❑DAIRY 6 <br /> ❑LAND USE APPLICATION S7E6 <br /> F-1 SEPT PUMPER TRUCK/ DH.Nc <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> n WASTEWATER TREATMENT PLANT <br /> ❑HOUSING ABATEMET 7 <br /> COPA <br /> 1:" <br /> TEtIHOTELCKEN RANCH/DDG KENNEL <br /> BIt CUPA-UST <br /> A <br /> ,TOO/aODY PIERCING <br /> 6 $qlo WnsTE <br /> MPLAINT <br /> ❑7DTHER(PLEASE SPECIFY): <br /> D ACWDNDHG <br /> 10 <br /> •••BDxED AREA-EHD USE ONLY•'• <br /> ° Records provided by Staff-PPR Complete. suiff Name: <br /> EHD 4806 <br />