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sny_'aluij panNaaaa <br /> DATE RECEIVED SAN JOAQUIN COUILU '°N AUKS :6 91Ob 'b ' <br /> glLj 0 fl 216 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-8232 <br /> vVIRC A-€GfALtiE4t11f' <br /> :Ert:RITIBERViCES ,Telephone: (209) 468-3420 Fax: (209)464-0138 Web: WWW.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT- BUS€NESSIAGENCY: /tom <br /> ADDRESS: <br /> �+ f �� i4i"Ci ID CITYISTATFJZT; rrrP�7ULD , �I q <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> ppreeSI • , <br /> Please allow 10 business days from data of application submhta11 for a records tgbe vallable. <br /> Staff will contact you to arrpge an appointment date and time to review rhe requested records. <br /> ❑ CHECK BOX TO EXPEDIJ RE0 JT_$13O ffE SH R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF AFPL1 f C DATE 11,0 <br /> Electronic Information: I❑ List❑ M2p crlptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Sstreet i Street Name city <br /> t i <br /> 1. LDi I LOW y� - <br /> 2. nUnit t <br /> 11 p i I <br /> 3. N r ^Llnty '/n�Yl. " U-H 2 <br /> 4 JL1� Unit 2H <br /> E�Us. — d �3 ver <br /> 7. <br /> li. <br /> SITE MITIGATION 1 <br /> g. <br /> i0. p ❑ units <br /> SpecHlc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP Si;ra(LOP) ❑MEDICAL WASTE FACILITY ElSOLID WASTE FAC€.rrYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HousWO ASA maul ❑S:'ASTE TIRE <br /> MAUNDERGROUND TANK(MONITORWVREMOVAL) ❑FOOD FACLnY CI DAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANOHI DOC KENNEL ❑WAsTEWATccR TREATYEN7 PLANT <br /> HAZARDOUS WASTE(HA7.RRDOUS MATER" ❑MOTES(HOTEL ❑PUMPER TRUCKNAROICHEMICALTOILETS <br /> t--I <br /> Timm PPRMirrm FACILITY ❑POoL1$PA ❑LAND USE APPLY..AT.V'n SITES <br /> r-1 TATTOomooy P=RCING ❑COMPLANITIRESPOWE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:60 ANI-5:0opm(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of Rise from the list above by checking the appmPrizta <br /> box(es). At least one file type MUST be selected. Fox to(2091464-0138 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 flies exist An appointment for review will be confirmed approximately tan(50) <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 EHD staff at the expense of the applicant <br /> Future flie reviews by the same applicant may require a$130 deposit prior to review. —BOXED AREA-EHD USE ONLY— <br /> FF <br /> Records provided by Staff-PPR Complete. start Name: <br /> 7/1/46 <br /> END 6806 <br /> fA <br /> a ;aB <br /> n M <br /> T S£TOb9S60ZT ZZS9ZOZ6SST Wtl£S6 9TOVS04 0 <br />