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' DATE RECEIVED N W 0 '6Z 'u'P,taw11 p;A 1 ;0
<br /> _ �• SAN JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br /> 7013 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd
<br /> �,�fi . EY�L -rY1-r�LZi1 PUBLIC RECORDS RELEASE APPLICATION
<br /> APPLICANT:. �;,' � p� ,' BUSINESS/AGENCY: ,;
<br /> ADDRESS: 3e/3q dfgjsj2.,Z Ayt. 5(c- C CITY/STATE/ZIP: &W r. ,,.-
<br /> PHONE(1); g(6) yfo.- oZ-3G PHONE (2): (��,� — 3qgc FACSIMILE: hit .,ga- 0(0®3
<br /> TENTATIVE"APPOINTMENT DATE: Time:
<br /> (Please allow 10 business days from date of application sybmlttal-'Tentative only-must be confirmed)
<br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT DATET`tp,
<br /> Electronic Information: ❑ List❑ Map—Description:
<br /> FILE ADDRESS _ EHD USE ONLY
<br /> Street# Street Name Clty L,Unit 1
<br /> 2.
<br /> _. 0 Una 2
<br /> 3.
<br /> 4.
<br /> I�Unit 3
<br /> Z
<br /> ^ TrwS e CIC ova -i1e G.a 4. Zj,.Unit 4
<br /> 7.
<br /> 8. - .
<br /> Unit 5
<br /> 10.
<br /> Q"Units 1E
<br /> Specific Date Range of Information Requested: From ('loo to ✓ •�
<br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES V
<br /> K
<br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) [✓1GIEDICAL WASTE FACILITY 21 LID WASTE FACn-ITYIVEHtCLE
<br /> ER CLEANUP SITE(NON-LOP) [ : - - 2WASTE TIRE
<br /> 5ERGROUND TANK(MONITORINGIREMOVAL) - i/ M Now AIRY
<br /> BOVEGROUND TANK reHICKEN RANCHI DOG KENNEL ,]WASTEWATER TREATMENT PLANT
<br /> 2VAZARDOUS WASTFJHAZARDOUS MATERIALS R III(OTELIHOTEL �MPER TRUCKNARDICHEMI:AL TOILETS
<br /> [�JIIERED PERMITTED FACILITY [;�FOOLISPA 21:AND USE APPLICATION SITE
<br /> 91 TTOOIBODY PIERCING CKOMPLAINT/RESPONSE RECORDS 20THER(PLEASE SPECIFY)
<br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR ReviEw: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS)
<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(209)464-0138 or mail to the address indic3Led above. Address
<br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after
<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).
<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 /> 3. A file that is actively being worked on by EHD 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 ay licant.
<br /> --,..
<br /> Future file reviews by the same applicant may require a$125 deposit prior to review. � L3E'1 �1R -"'EHD USE,O,N<Y
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