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85L5 '°N W "'8 ti101 Ol 'add Y!1 PaAIaaa� <br /> EHD LOG NUMBER <br /> DATE REC LVED /);� � l7 SAN JOAQUIN COUN 2L <br /> U'��; V 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 /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: e Y� fl&VA\kr q' , BUSINESS/AGENCY: (Cn -V <br /> ADDRESS: `0 Z t1PD � '6 2CITY/STATEIZIP: Cl ( l an L� <br /> PHONE(1). `70-7 �.i�j��3 PHONE(2): CQG—G qeS ��7�o xI��FACSIMILE: <br /> Time: <br /> TENTATIVE`APPOINTMENT DATE: <br /> tive only-must be confirmed) <br /> (Please allow 10 business days from data of application submittal-•Tenta <br /> ❑ CHECK BOX TO F'SPEDITE REQU T-$-125F H O s CK ONLY)-REQUEST PROC DATESED IN 3 BUSINESS+DAYS <br /> �� <br /> 41 <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: <br /> [0"List Cj IMlap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> R <br /> Street Name City 171 Unit 1 <br /> Li <br /> �b \ L cmc Z�6'0 <br /> y <br /> 1 ' Unit b <br /> 6. <br /> 7. l7�� �(I►�l/l AAW <br /> ❑Unit 5 <br /> 8. <br /> 9. <br /> ❑Unit 6 <br /> 10 <br /> .L <br /> specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYNEHtcLE <br /> [ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q MEDICAL WASTE FACILnY ❑ <br /> [OTHER CLEANUP SITE(Nom-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> ❑ <br /> UNDERGROUND TANK(MONfrORINGIREMOVAL) ❑ <br /> FOOD FACILITY ❑DAIRY <br /> ABOyESROUND TANK ❑CHICKEN RANcHI DOG KENNEL ✓WASTEWATER TREATMENT PLANT <br /> Q BOVEDOUSWASTFIHAZARDOUSMATERIALS ❑MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALToiLETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA LAND USEAPPLICATION SITESCOMPL AiNTIRESPONSE rr�-RECORDS L:3 OTHER(PLEASE SPECIFY) <br /> ❑TATTOO/BODY PIERCING <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXGLUDINf3 HOLIDAYS) <br /> 1, List up t4 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 2091464-01.38 r mail t the D, i icatio received <br /> 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 /> staff may not be immediately available for review. Anew application maybe <br /> 3. A file that is actively being worked on by EHD <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. a <br /> u <br /> ❑❑1 <br /> EHD 48-06 130 <br /> 1 <br /> 1 <br />