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a SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �)� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> LMAY 0 2 2 13 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �\ UQM — -Telephone:(209)468-3420-Fax:(209)464=0138 Web: www.sjgov.org/efid — <br /> � <br /> ENVR,'Y4MFNTAI ..EAL W` PEV_NlrF/<Y .(ICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Gj (egarw KO(US- BUSINESS/AGENCY: (ARS <br /> ADDRESS: ;lg'W_"&Cj'6j6tX &k5 Wk S4")-r a3fJ CITYISTATEIZIP: ,SS'CI-19?07 the ✓ I9 �S <br /> PHONE (1): % 67q--0l0-71 PHONE (2): % 7/e-63y7 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'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 DATE <br /> Electronic Information: VLIst❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> + o R o�� Roo {gyp �{ Ire, W, <br /> 2. l/I-A C i k �•lb, De0f Jon Jo - �Gr t Int ❑Unit 2 <br /> 3. '— /& <br /> 4. or IJ — r Unit 3 <br /> 5• "r S A LJPAC L1'I"-i I�S !Veer, 6-6e) rl <br /> 6. r <br /> IF <br /> nit 4 <br /> 7. <br /> 8. <br /> El Unit 5 <br /> s. sF. rpm <br /> 10• 2-9vC`I 2 t to o ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITTNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <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) <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 indicated 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. *"BOXED AREA.EHD USE ONLY"* <br /> r (AST C 0 t V d;r Ke skqrpe_ r <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 914112 <br />