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EHD LOG NUMBER <br />fl HOUSING ABATEMENT <br />0 FOOD FACILITY <br />D DOG KENNEL <br />CHICKEN RANCH <br />El MOTEUHOTEL <br />El POOLISPA <br />D COMPLAINT RECORDS <br />SOLID WASTE FACILITYNEHICLE <br />D WASTE TIRE <br />0 DAIRY <br />0 WASTEWATER TREATMENT PLANT <br />LII PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />LAND USE APPLICATION SITES <br />D OTHER (PLEASE SPECIFY) <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />THER CLEANUP SITE (Nom-LOP) <br />NDERGROUND TANK (MONITORING/REMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />JKTIERED PERMITTED FACILITY <br />D TATTOO/BODY PIERCING <br />0 MEDICAL WASTE FACILITY <br />NIP )1,! <br />DATE RECEIVED <br />qix i^,ria SAN JOAQUIN COUNTY oti viovfiv. ENVIRONMENTAL HEALTH DEPARTMENT <br />CA-i— ci: ,;t 5 if 671 <br /> <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orgiehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: f// Re, BUSINESS/AGENCY: <br />ADDRESS: '/& 60*(6-25 6;0305.- :52 >17:4- E CITY/STATE/ZIP: 5 276-1 75-e9W <br />PHONE (1): ' 9/6- 37, yz ...„1.2676, PHONE (2): ,c7/Z 27Z5,/ FACSIMILE: ?//‘ 5 9 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tentative only- must be confirmed) <br />LII CHECK BOX TO EXPEDITE REQUW .rEg (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DA S <br />SIGNATURE OF APPLICANT$(//1"' DATE , <br />1 Electronic Information: LI List.Lii Map - Description: <br />I <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name City D Unit 1 <br />1' 3t7 / /Vi. Wit- 5-01A1/ PAP'57-oeft-47--a4/, <br />5-7aCe7roW <br />I c.,..o <br />)\-k5 D Unit 2 2.97-15----- A/ Wit._ 50/V1 k 9' <br /> I/00 / /14. bli/L56.'/V )4/ti/ uri S--7Ck.7.&A./ / 0 <br />te I))1 ‘11 /4 _ --- 11-06 7 iv. pv-IL C-K-74., <br />5' t/../ 0,5- /V i f i / L 5-0/1/ dVd y $7-1.0< "7-67A/ <br />. <br />/o/O / ,.2- D Unit 4 . 6' 900 :cc Ali Wit- 5'677V h71/1:9- Yi 5-i'ci;-7-"i/t/ <br /> <br />LI Unit 5 <br /> <br />0 Unit 6 <br />pacific Date Range of Information Requested; From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />to <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />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 - for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />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 />A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br />submitted when the file is available. <br />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. <br />EHD USE ONLY <br />EHD AS-06 <br />811/11