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�J 9LZti'ON Wd6w. EHZ '6 '100 aWII P;AIaaay <br />SAN JOAQUIN COUNTY^ t� <br />QST X013 ENVIRONMENTAL HEALTH DEPARTMENT j t <br />1868 East Hazelton Avenue, Stockton. CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/elrd-"I ^► <br />iii NTALHEA T <br />PUBLIC RECORDS RELEASE APPLICATION r7 <br />APPLICANT- rinsly, BUSINESS/AGENCY: <br />ADDRESS: 14s -I V.Zwr i?0.v Qr Sit loo CITYISTATE/ZIP: �a ., o6p_w&r rA 9x815 <br />PHONE (1): 616 PHONE (2):�2t- S{{o FACSIMILE: Ale{�' obo3 <br />TEN ATI E'APPOINTMENT DATE:AP Time: <br />ata <br />(Please allow 10 business days from do apPllmtlon aubmltfal -'Tentative only - must be confirmed) <br />L7 CHECK BOX TO EXPEDITE REQUEST- 25 FEE (GASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT g 14�r DATE C9&1et, 7o l3__ <br />V <br />J <br />Electronic Information: ❑ List ❑ Map -Description, <br />FILE ADDRESS <br />END USE ONLY <br />Street N <br />Street Name <br />city." <br />�Q <br />nit 1 <br />1. <br />20 <br />Tur r <br />lAd: <br />HA, MM <br />norrsp <br />2. <br />( <br />_.. <br />1,4; ,� <br />n1De? <br />OL, Ccs <br />Unit2 <br />3. <br />J <br />WeLl Tu~v Raej <br />_ <br />B�CClt <br />Unit9 <br />4• clo <br />Tw <br />r C <br />5• <br />S 4 <br />a <br />�^^ <br />(.�: <br />E2/u-It4 <br />6• Ito <br />i"AS�' 'fu rnar <br />7. <br />y1runit 5 <br />B. <br />9. <br />Unit e <br />10. <br />Specific Data Range of Information Requested: From <br />'ROUND TANK (UST) CLEANUP SITE (LOP) <br />CLEANUP SITE (Nom -LOP) <br />!ROUND TANK (MONITORINGIREMOVAL) <br />!ROUND TANK <br />))US WASTEIHAZARDOUS MATERIALS <br />PERMITTED FACILITY <br />VBODY PIERCING <br />MEDICAL WASTE FACILITY <br />HOUSING ABATEMENT <br />FOOD FACILITY <br />CHICKEN RANCH/ DOG KENNEL <br />RECORDS <br />10 <br />H <br />ro DKStr�T v <br />IDWASTE FACILrrY1VEHICLE <br />NSTE TRE )o Cp yl <br />]AIRY t IX .47). <br />NASTEwATERTREATMENT PLANT \0'1 <br />�U PER TRUCKNARDICNEMICAL TOILETS <br />�USE APPLICATION SUES �} <br />FR(PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING <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 1209) 404-0139 or mall to the address Indicated above. Address <br />ranges will not his accepted -for additional assistance with file addresses, contact the END. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The END will notify the applicant H any END files exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3. A file that Is activelybeing worked on by END 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 END staff at the expense of the <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />" 1. -l vva zC:zl Rlnz/Rn/rel <br />