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RECTRNED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENViRONMENTAL HEALTH DEPARTMENT <br /> MAR 3 20W 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0133 Web: www.sigov.org/ehd <br /> EKMP'0N'W'B%qAL HEALTH <br /> -TISF 'PRML-5 <br /> PUBLIC RECORDS RELEASE APPLICATION t <br /> F ILI <br /> APPLICANT:-._�Vv� V'�' 'huvvt VU N'Y'� BUSINESSIAGENCY: <br /> ADDRESS: Zisb� Q-w\_U0 CITY/STATE/ZIP: <br /> A <br /> PHONE(1): � PHONE(2): VM�,�� I U�Iq FACSIWHLE:�CJLS) AU; -UE"Icl <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 /> F <br /> CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH 0C'HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICART M9 SLLA.- vl+� "tR DATE <br /> Electronic Information: E] List[] Map-Description: <br /> FILE ADDRESS <br /> Street Street Name City EHD USE ONLY <br /> 7,112- VD fC-1 <br /> Ln v_&�M 1 -1 k�p u-) Unit 1 <br /> 3. 0 <br /> — [S�/Unit 2 <br /> 4. <br /> 19/Un it 2 H <br /> 5. <br /> 6. 13 <br /> Unit n <br /> El Unit 4 <br /> S. SET_.,*IIGATION <br /> I lo. <br /> V(DUnit <br /> Specific Date Range of Information Requested: From 7 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 5 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 MEDICAL WASTE FACILITY SOLID WASTE FACILITY[VEHICLE AV S(L) <br /> OTHER CLEANUP SITE(NON-LOP) F7 HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) FOOD FACILITY DAIRY <br /> DA13OVEGROUND TANK CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> 9 HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTEL/HOTEL PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> LITTERED PERMITTED FACILITY POOL/SPA LAND USE APPLICATION SITES <br /> U TATTOO/BODY PIERCING COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (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 ONLY*** <br /> ,L2_Records provided by Staff-PPR Complete.Staff Name: <br /> EHD 4M6 711115 <br />