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ENV, MENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 " t <br /> r Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd ' <br /> G? � <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: 7 {� <br /> ADDRESS: �� A L�'clr'J' -0 tit <br /> CITYISTATErzIP: �j �} <br /> PHONE(1): 5,59 99q-qaj l PHONE(2): FACSIMILE: 5Q /y <br /> TENTATIVE*APPOINTMENT DATE: Time: QCA f+yl P <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirm <br /> ❑ CHECK BOX TO EXPEDITE REQU T-$125 F (C H O CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS PAYS <br /> SIGNATURE OF APPLICANTDATE `Z <br /> Electronic Information: ,❑List ❑Map- escription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city 171 Unit 1 <br /> 2. �f f Unit 2 <br /> 3. <br /> 4. -u it 3 ! <br /> 5. , <br /> 6. r nit4 <br /> 7. 7-a3.ILI- o s �� ire �etv <br /> c o cci+ C Cee_ in r�v�8µ/ Frfr�s. rov:rQ� cvlqT:s 0r' - (�llOw.r19 <br /> 8. /e.Vi Unit 5 <br /> 0 ;in' i r <br /> 9. .V ���- ." i r / w '1 t�Zf (?.1-3 ar t!000Z"1 q5 <br /> 10. D9 , C'b%1Iii 7 jl t� 1.0001-I`3 S 1 4900 1�X27, X1710 iU{J014(tlb,W00/(�l�Unit6 <br /> 1 t } N <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ( � <br /> EgUNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE W/1 <br /> OTHERCLEANUPSITE(NON•LOP) HOUSING ABATEMENT WASTE TIRE ..l rJ c <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)�'' FOOD FACILITY DAIRY ��= r_, <br /> ABOVEGROUND TANK V-- CHICKEN RANCHfDOG KENNEL WASTEWATER TREATMENT PLANT <br /> �HAZARDOUS WASTEIHAZARDOUSMATERIALS C4- MOTELIHOTEL PUMPER TRUCKNARDICHEMICALT01LE11-4 <br /> ❑TIERED PERMITTED FACILITY POOLISPA LAND USE APPLICATION SITES Imo-L(1 i$3i <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) 8 S <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 �,s <br /> box(es). At least one file type MUST be selected. Fax to(2091 464-0138 or mail to the address indicated above Address o U Bo a <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after Vl <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10)"�- :a— <br /> �� <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. Ih <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be 3� 3 <br /> submitted when the file is available. <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$125 deposit prior to review. BOXEDREH1;US _oNLYI <br /> -: <br /> = <br /> 0-41 <br /> EHD 48-08 — - - — 914112 <br /> 231 y t E771 f �� Hvv .� t:Dt7 5 ' j T�! ►' Jz. cg3l isq 8 ro G5 4 <br /> to 12-gG /Q} (��ff, j�j3t l' iO b.�F►i0(� S :+t <br /> (114 t0� �t y Z(���'Pt);n I ti re• ��a�ucl� (�Pt);� 4,,v b-k. ��°a X34 ��p�'21 ,s p�Il rpf; 5��to <br /> ©� �pIn0t)."/, U, ���r° 0oCt7a�l5� �t-�;., 14+� hIe U)v01G3-rl(gt-3,06) :r, Nvd fill• 60001 135.1 ); <br /> Wvf FT I -, w 001-7 a1- ep-rpy 0 rpt S10t)rA AIr, COW 1-7(0 s�o rpt);, Htit�`h(r�. c�oUMIL4 (rA'i 510(0 hl•a. <br />