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DATE RECEIVED SAN JOAQUINCOZ90I°N W �. Wil pa-nia�a� <br /> RECOVED ENVIRONMENTAL HEALTH DEPAR <br /> Q� o 20T 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd ✓ <br /> ENV)RONMENIAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KV U IY� ` BUSINESS/AGENCY: T Teck <br /> ADDRESS: `2 WcCe CITY/STATEIZIP: CACAl GUS. ,C'�L <br /> PHONE(1):(qj&') Ip a-! A26 X ISI PHONE(2): FAX OR E-MAIL: , LrA <br /> Please allow 10 business days from date of application submittal for the records to be availab e.AO }gl }�CjV.tc <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK;SOXTO�EXP,EDfTE.REO=ES�,T.n=•$950;FEE.(C'ASH 0I?„CHECK:ONLY):,",f2EOUE3Ti(PROCESSED IN,3:BUSINESSiDAY,S <br /> SIGNATURE OF APPLICANT DATE V 2 (� <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> 1. d$D LtVt2 <br /> Unit 1 <br /> 2. <br /> 3• unit 2 <br /> 4• Unit 2H v <br /> `dol <br /> S. 126nit3 je,, 14DOIJ <br /> 6. <br /> nit 3HM <br /> 7. <br /> p Unit a <br /> S• SITE MITIGATION <br /> 9. <br /> 10. L�'(Init 5 <br /> Spocific Date Range of Infonnaeon Requested: From to <br /> IF�3NA :._L?H X'THOEFARRTMENTNF,ILE$ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) tz MOTEEMOTEL SOLID WASTE FACILfTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) tK HOUSING ABATEMENT 29 FOOD FACILITY <br /> UNDERGROUND TANK(MONrroRING/REMOVAL) 66 WASTE TIRE DAIRY,POOLISPA <br /> ABOVEGROUND TANK CHICKEN RANCHI DOG KE4NEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE MEDICAL WASTE FACILITY ®PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> AZAROOUS MATERIALS 7�I TATTOO/BODY PIERCING IMLAND USE APPLICATION SITES <br /> �.TIEREO PERMITTED FACILITY 0 COMPLAINTIRESPONSE RECORDS Y;OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the typa(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 mall 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 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 approximately ten(10) <br /> days after receipt of application. The Nlas will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4 Any fila nct rat;, nod in t.`.a sa...a aunditicn as rcicas-d sal ba' orga, ad by EHD- .1 at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$13D deposit prior to review. <br /> "'BOXED AREA•EHD USE ONLY' <br /> ■ <br /> ❑ Records provided by Staff-PPR Complete. staff Name: %0 <br /> %0 <br /> 0 <br /> T000/TO00 QJ 'ONI H031 'VInal 9996£E99T6 IV3 IQ4 C6�6 9T07/0C/C p <br />