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rZ vCLAVt- EiV an'ia�a <br /> DATERECENED d SAN JOAQUIN Cou6880 '°N WdS� '' 9lOb 'El '00P .1 P N <br /> jUN 13 2016 LIWRONMENTAL HEALTH DEPARTMENT 2 <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 ,1(�• <br /> CPIYiIRONtNENTALHEALIephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PGRMiTdSERVICE8,- ' PUBLIC RECORDS RELEASE APPLICATION <br /> >'PLICANT: BUSINESSIAGENCY: <br /> ADDRESS: S VNII tr- O CITY/STATEIZIP: I.f�' Pyr 1 of?PO <br /> PHONE(1): 7(`ij co 3 PHONE(2): FAX OR E-MAIL' dctjLF�lC°GOTOEPC• a* <br /> Please allow 10 business days from date of application submittal for the records to be availab9e. <br /> Staff will contact you to arrange an appointrnent date and time to review the requested records. <br /> WMI R510 m-,0000 IM R; <br /> INEWL'to 'r BREW"" <br /> .11 <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below ct 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 after3:00 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 approximatelyten(10) <br /> days after receipt of appiieatlon. 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. - <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electrorlc Imforma.tion: ❑ List ❑ Map-Description: <br /> Specific Date Range of Information Requested: From ap L, to <br /> FILE ADDRESS 1(O StiY�sw- rpt <br /> EHD USE ONLY&- -1b <br /> �UNDEnRCIJNO TANK(UST) C,'�y/� Street Street Name City /� <br /> CI NUP SITE(LOP) -4 V. <br /> ; , r Y. .( (.{yr.._ (,sem„ 1,% <br /> j QIHER CLEANUP SRe(NcA 1.0 �( ^� <br /> is Hv_ARDOUs WASTE 13 DAIRY <br /> n TIERED PERMIT ED FACILRY 1 <br /> t9 AEOVEGROUND TANK <br /> SUST WONRORNG/REMOVAL) ❑PW9 <br /> �J'USARDDU6 NA'ERW.s O <br /> 5�-a^PILURELEASE RESPONSE <br /> 71SOLID WAs E FACILRY/VEHICLE A r't <br /> M FOOD FACIL" <br /> POOL/SPA ms MD1WTIOH <br /> DAIRY E <br /> LAND USE APRICATM SrITS <br /> ❑Hasroc <br /> n SEP11C PUMPER TRUCK/ s . <br /> YARD/CHEMICAL TOILETS / <br /> WASTEY"ATERTREATM PI-ANT ®COPA <br /> HOUSM AEATEIV!EW T <br /> MOTPLHOTEc <br /> E]CHICKEN RANCH/DOD KENNEL COPA.HA AT <br /> 8 <br /> MEDICAL WASTE FAtTLRY <br /> OTATTOO/BODYPIERCINO - 13SOLD WASTE <br /> WASTE TIRE 9 <br /> CGNPWNT <br /> n OTHER(PLEASE SPECIFY): 0 Aco]vxTING <br /> 10 <br /> -"BOXED AREA•EHD USE ONLY"* <br /> l <br /> ;5 <br /> -1 V-4 1.4 a�s <br /> Records provided by Sta -PPR Complete. staff Name: s� <br /> T6009-8EL-E1Z 2utgjnsuoO aseyd UOJSAu3 WdET :E 910Z 61 unr®� <br />