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DATE RECEIVED - EHD LOG NUMBER <br /> SAN JOAQUIN COUNTIYL E COn I <br /> 4 <br /> ';!1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 � ' 1 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:^ Pin. BUSINESS/AGENCY: Pn1 <br /> ADDRESS: 3�•(op pxu�twt glval Ste. )oo CITY/STATE/ZIP: 9. ,4ltkF[.Aq5-6t,l <br /> PHONE (1): gLts- 3-1-79. PHONE(2): (9z, ) 27-o-3K`�D FACSIMILE: dA <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE lo��lsoi`l <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Q Un(t 1 <br /> lclo � ut �r� hsU4Eor- ll� I C'U <br /> lel 1 0Unit 2 V <br /> 3. - <br /> 4. -16o , I El Unit 3 <br /> 5. <br /> 6. ❑'unit_a <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. ` J� 6 El unit s <br /> Specific Date Range of Information Requested: From I`kcm to ,,.e. A <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �" <br /> F-- NDERGROUND TANK(UST`CLEANUP SITE(LOP) ['MEDICAL WASTE FACILITY [SOLID WASTE FACILITY/VEHICLE <br /> �THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT /ASTE TIRE <br /> [�ftNDERGROUND TANK(MONITORINGIREMOVAL) ❑F9.OD FACILITY U 5AIRY <br /> Q-CBOVEGROUND TANK HICKEN RANCH/DOG KENNEL ['WASTEWATER TREATMENT PLANT <br /> ED-WAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL gTUMPER TRUCK/YARDICHEMICAL TOILETS <br /> [aTIERED PERMITTED FACILITY 2fOOLISPA Q LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING [3-COMPLAINTIRESPONSE RECORDS ['OTHER(PLEASE SPECIFY) EA,Jk�aNnE�-N rA4 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) c'"it ERl1 <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,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 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 file reviews by the same applicant may require a$130 deposit prior to review. `BOXED AREA-EHD USE ONLY" <br /> ❑ Records provided by Staff-PPR Complete.Staff Name: <br /> EHD 4M6 OB/01114 <br />