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ENV#N liNTAL_HEALTH DEPARTMEA <br /> 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 /> -R V N g,::[7� <br /> APPLICANT: 16(M8 a"7_ B SINESSIAGENCY: _PA <br /> 0 <br /> ADDRESS: 44 CITYISTATEIZIP: ] � <br /> PHONE(1): qqq PHONE(2): FACSIMILE: 6affiekell, <br /> TENTATIVE*APPOINTMENT DATE: Time: OrA <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed <br /> CHECK BOX TO EXPEDITE REQUIJV-$125 F (CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS AYS <br /> SIGNATURE OF APPLICANT =- — DATE <br /> Electronic information: F1 List n Map-Ibescription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> Unit 1 <br /> Al ftkAl t? r <br /> 2. VL-d rl Unit 2 <br /> 3. LEI 6T <br /> 4. Unit 3 <br /> 6. <br /> 1 <br /> 6. djn�,t 4 <br /> 7. <br /> J04 (d� of gAk (Jmm damfn-rA'4)r-y_- um A' <br /> 8. ; Units <br /> 6a g4I Pe <br /> 9. <br /> , <br /> 1 <br /> q 50 Z-015 C'&%1u1q 5 5 1 Co 0 0 1-7-X2 1;2_7-7. 1-7(0 <br /> 5, <br /> 10. (10I)IIII(q, j46jQJ(IIk , []Unit 6 <br /> Specific Date Range of lnforrr�atlon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FI—LES . <br /> [8UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FAclUTYNEHIC*E, <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE 14 <br /> UNDERGROUND TANK(MONITOMNGIREMOVAQ:Z-''' FOOD FACILITY DAIRY 5, <br /> ABOVEGROUND TANK CHICKEN RANCH[Doo KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WATEIHAzARDous MATERIALSD4- MOTEL HOTEL PUMPER TRUCKIYARDICHEMICAL TOILE1 <br /> ❑TIERED PERMITTED FACILITYPOOLISPA LAND USE APPLICATION SITES \'J-� <br /> ❑TATTOOIBODY PIERCING \"'ompLAiNTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) \1\ <br /> // C'( :�:5 M", <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List u12 to ten ijddresses in the space above. Select the type(s)of files from the list above by checking the appropriate 7','j <br /> box(es). At least one file type MUST be selected. Fax to(209)464&138 or mail tothe address indicated above. Address 12 4_to � <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after \Jl <br /> 3:00 pm will be processed the next business day. 4- <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10)"-�- :B <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments men <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 now application may be ::z- <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. ff,_M, <br /> 00-a—WO-01's <br /> EMD 48-06 <br /> -7131 Y 4?RMI I b 66,trd-,/i ft, hle- u)0D51q4-7,2 <br /> 9/4(12 <br /> 4W 12qq <br /> Q El 7- 6, W03.. 50ho <br /> q -r-P kP-0) & r4l e co o_-)do i§-3 V-rp h 0101 -3-7 &:-7106) 600DII-5 <br /> LoOOi-VO r,01 0,r,,:7f IA I+W Kiel COW 1-7(0 r-(07 rJ9"' "A H(,-, 1p, <br />