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Ir F <br /> DATE RECEIVED (' <br /> �{L g� � U ����f..rb SAN.JOAQUIN COUNTY EHD LOG NUMBER <br /> 3 ENVIRONMENTAL HEALTH DEPARTMENT 8491467 hiV{RONf.AFNT,4LHEALTH_ 1: (2 East Hazelton Avenue, Stockton, CA b:www.sig <br /> ?ERfu iTlSER:!",CES Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orglehd <br /> PUBLIC RECORDS RELEASE APPLICATION C <br /> APPLICANT: rqo I ;t�i / ky1 I l d1 BUSINESS/AGENCY: �.t�,L L2/I SU( I1 Acc <br /> ADDRESS: ZpL{ I(f.e. S4,wpA:ft310 CITYISTATEIZIP: <br /> PHONE(1): a 4 O'Z 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 review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IIJ 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT %2 j(2i-Jz -yJ/i 'n^ DATE i7/ (r <br /> 1. List uo 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 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 8139 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: H"List❑ Map— Description: <br /> Specific Date Range of Information Requested: From _Ef S-) wGIJCAI Le to jJFJFnA <br /> ENVIRONMENTAL '1_CD i/J�U�J I e. <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> uNDERE�LND TSNA(UST) Street# Street Name City r)> <br /> CLEANUP S,TE(LOP) '] .rY I,.,�,/ �� OZ unen <br /> �• Ea6E CLEANUP SUE(NOM' 1 38O'D Wes4 ���. Chub UL� S �,-X.�([� A <br /> �HAURDDUS WASTE 'L/ <br /> 12 <br /> IERED PERMUTED ffcrtm Z /'� / ❑Duan �'�^ <br /> gA.0VEC uND TAN. VY L <br /> MIST (MONRONNG/REMOVAL) 0 Pyyy <br /> ZH/SAROOUS MATER'AL£ <br /> 2_9;IWREtEASE RESPONSE <br /> ❑SOUD WLSIE FAC /VERCLE 4 <br /> WATER W4m <br /> ❑FOOD FACILItt <br /> ❑POOL/SPA <br /> SRE MniGATgN <br /> ❑DAIRY 6 <br /> ❑LAND USE APPLICATION SMS <br /> 'SEPTq PUMPER TRL(../ E]Hy51N;: <br /> 6 <br /> YARD I CNEMIGL TOILETS <br /> ❑WASTEWATER TREATMENT PUNT <br /> ❑HOUiDNO ASREMENT T ffl`CUPA <br /> MOTELNOTEL <br /> ❑CNIL.Ex RANCH/DOC KENNEL <br /> CUPA US <br /> MEGCAL WAETE FACIIIry E <br /> ❑TATTOWBODY RERGNG <br /> ❑WASTE TIFF 0 <br /> B <br /> ❑COMPWNT <br /> ❑OTHEA[PL ESPECIFY): <br /> 10 (]A'xxxi"mN3 <br /> —15OXED AREA EHD USE ONLY`^ <br /> 0 Records provided by Staff-PPR Complete. Buff Nem.: <br /> EMD Y-06 <br />