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RECEIVED 0 SAN JOAQUIN COUNTY ftSHEHD <br /> LOG NUMBER <br /> Mia 0 5 20 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> t'!bMRONM1ENIAL HMTH <br /> PEWITISEfTVrAE-3 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 6144- Vlcx BUSINESS/AGENCY: 10i?1921 tf 1fSaL//}TES <br /> ADDRESS: g3,�?49 4',7'P4Ve­E:' Cr/Q O S5U/7G -E CITYISTATE/21P:s <br /> PHONE(1): 'J'/( j 61/ ?fidO PHONE(2): 9/,4 dJ.y'tS ?2k79/ FACSIMILE: 9/6' Stili .2.7Z? <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-$)30 FEE OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN SS DA'S -11,5?SIGf ATURE OF APPLICANT DATE 3��J It <br /> FElectroniclnformation: ❑List 0 Map-Description: <br /> FILE ADDRESS HD USE 0 tr <br /> street# Street Name City 3 US `t � �CS• )� 34-1 � <br /> ❑Unit 1 <br /> 01,: Z25 Noa� co y� <br /> 2. <br /> nit2 <br /> t� 3. O Fr LauCSE' ✓ ��t7 Gid do Lly- ,,v0u t / <br /> l 4' 19 ilk Unit 3 <br /> a � �, L-4rJ/S� l !T oP M0 a� T i ND <br /> D�fR <br /> 6. J5I <br /> T. wo S# D fLE )"/Ny A� ND tt I <br /> a. <br /> ❑Unit 5 <br /> 9. <br /> Specific Date Range of information Requested: From to rnt il�wl e�f-1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONTTORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH)DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un 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)464-0139 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 END records, please contact END at the number noted above. <br /> 3. The END will notify the applicant If any END 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 END 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-END USE ONLY' <br /> 0 Records provided by Staff-PPR Complete. staff Name: <br /> EHD 4e-06 <br /> OWIA4 <br />