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is <br /> ME" <br /> DATESep• 22, 2M 2: 12FM No, 1911 P. 1, <br /> Et 3 NUMBER <br /> aye SAN JOAQUIfV COUNTY <br /> aa� ENVIRONMENTAL HEALTH QEPARTf EMIT <br /> ®12 1868 East Hazelton Avenue, Stockton, CR 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: WWW.Sjgov.org/ehd <br /> per. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ./ 6--hl� lut1-6) BUSINESS/AGENCY: S COC(jTr,-i Pttb! C iA/(I`J <br /> ADDRESS: to �- �qC(/C,eitJyr Ave CITY/STATE/ZIP: ��'W6-601 alSL S <br /> PHONE (1): (?D �K� ,5 PHONE (2): FACSIMILE: 1 �(��1 2,1q9 <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 RST-$1 FEE/CASH R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> EQ /L. "r✓ DATE <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS <br /> Street 9Street Name City vaEHD US NLY , <br /> Nle <br /> 2. l2S' -TDYh�UoOtAj/✓ Dn St-(-)opn '� f <br /> nnll �/ /� f`,7 lJnit 1 <br /> 3. ���/ I P, Wow a f , DI Ilei �}�j(�/%��' `lt,� 6�'°°°`�C,1 cLe,-cvp U d.It 2 <br /> 4. 2� � V i; t/l�a-AA Dn ve. S I C-OD�l ) -T-� (.1 cv.,- fl Unit 2H <br /> 5. -NTS Nr, W W a nrt Ov'bl/�fl <�vo� <br /> 6. 3297- -TJoryi t 4ia.W z- P�v r�-�Y�,, S�C -T-VY) �J F i EKUnit 3 <br /> 7. ��i"( I F—. --m1 ,9,haL 2- o IVti C0t2 co nit4 <br /> 8. Z10,p l 7' on vi Sou-Tm Q i-, ' Ism s; <br /> 9. <br /> 10. o u it s <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 FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-L OP) �HnUSINn ABATEMENT �::f".SiE T IRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY DAIRY <br /> ABOVEGROUND TANK ®CHICKEN RANCH/DOG KENNEL 2WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> Q TIERED PERMITTED FACILITY ;Ej POOLISPA I LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING 2 COMPLAINT/RESPONSE RECORDS g 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.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$130 deposit prior to review. '*BOXED AREA-EHD USE bNLY— <br /> (,to 00 to (-5 Co Un I Ga OLI V,,t Coy IjIXB 44r `$ov,*kKJ 10.- <br /> L � 7�u +-��l7 �AI �� 2 4i Ils'�ek 011 V 60 f.'01 ILA14 ldt77 <br /> --- -T, -r - 22,�'�2015' '270-9 PNi°No_ d- S& fName! <br /> Received ime-rS " <br /> e9621 <br /> EHD 4E-06 7!1!75 <br />