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EHD LOU NUMULK <br /> 6 RECF6I <br /> SAN JOAQUINCO''6_ 06 °N Md 0 ll SIOZ 'SZ 'AON awil PaAiaaa� <br /> , <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I�ln y -il 2 15 1868 East Hazelton Avenue, Stockton, CA 95205-6232 I <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd `Fm <br /> &VIRONMENTALHEA.UI PUBLIC RECORDS RELEASE APPLICATION 4� <br /> � <br /> —v�—rre�- 1 L <br /> APPLICANT' BUStNE,S(ACsERECY: P?�L c - g X <br /> ADDRESS: Z 1 2 r ��f�z 2 CITYISTATEMP:1 oC� i�� <br /> PHONE (1): 2-D9 -l-7000 PHONE (2): FACSIMILE: <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 F-XPEDITE REOUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ LISt❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streot 9 Street Name City <br /> [22. <br /> I;, Ij Unit 1 <br /> I343(n 2� ~O _ _ unit <br /> Unit 2H <br /> 6. 15 o I unit s rY� <br /> ..DnIt 4 <br /> 0 ITE MMOATION <br /> 8. <br /> 9. -1F3 "I <br /> �n li '' 'n� � � ii " QUnit 5 <br /> Specific Date Ranee of Information Requested: From to <br /> ENVIR0 lt��"EMTAL HEALTH OgoeaTMENT FILES <br /> auNDERDRDUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILrry ❑SOLID WASTE FACtUTYNEWCLE <br /> ,BOTHER CLEANUP SrtE(Nok-LOP) ❑HOUSING ABATadENT ❑WASTETIRE <br /> ❑UNDERGROUND TANK(MONITORWG1RENi0vAL) ❑FOOD FACILITY <br /> DAIRY <br /> ❑AsovEORouND TANK ❑CHICKEN RANCHI DOG FENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTE11fATARDOUS MATERIALS ❑MDTEIJHWEL ❑PUMPER TRUCKIYARDICHEmicAL To LM <br /> ❑ <br /> TIERED PERM ii ry FACw,i ❑D20LIg°A ❑_LAND USE APPLICATION SITES <br /> ❑TATTOOISoDY PIERCING R ComFLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFI') <br /> WELL AND SEPTIC PERMIT RECORDS ARE AYAIL.ABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> 1. List up M ten addressee In the space above. Select the typ°ts)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 2091484-0138 or mall to the addrers indicated Rbowe. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processod 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 /> will be confirmed <br /> 3. The EHD r re receipt <br /> of a plication.applicant If any The files wHD ill be held for a maxiles exist. An mum of Ova bent for us nese days for review. Appointments <br /> ely ton should <br /> (10) <br /> days after receipt of app <br /> should be scheduled accordingly. <br /> 4. Any file not returned In the same condition as released will be rrgan odtbey e i�staff <br /> anYvn AREA E p Use of thO SE ONLY* <br /> Future file reviews by the same applicant may require a$130 de sit pr1 <br /> ■ <br /> ■ <br /> w. <br /> Records provided by Staff-PPR Complete, surf Name: • <br /> MMS jn� <br /> El ■ <br /> ■ <br /> EHD saes ■ ■ <br /> TO/T0 :IDVd �OiN33 Adoo VO:ET STOZ/EZ/TT s a <br />