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DATE RECEIVED <br />klY3 I/ ( <br />,01A SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgiehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER cziln <br />APPLICANT:GYt le- or 6r/— BUSINESS/AGENCY: &C.k.. Oft.a- <br />ADDRESS: . • n.-% rot .b0.-rrt . CITY1STATE/ZIP: Lyrt"),5 80 5 2-tb <br />PHONE (1): t.303 -2 4„a, 3 —0 3a PHONE (2): FACSIMILE: 303 - gc) 3 - 0! 3Li <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 />LI CHECK BOX TO EXPEDITE REQUEST- $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT 6 DATE <br />I Electronic Information: • List ntap - Description: <br />I <br />FILE ADDRESS <br />END USE ONLY <br />- Street 4 Street Name City <br />'08 oc) Nor+h Tro,ci 4300104qt-el— —rib-, <br />q S 316 <br />I '1 <br />661- <br />• <br />0 uniti <br /> <br /> <br />1:1 Unit 2 <br /> ; <br />n unit 2H <br /> <br />EI Unit 3 <br /> <br />, u Unit 4 <br /> <br />III SITE MITIGATION <br /> <br />I-1 Unit 5 . <br /> <br />'pacific r.iatis Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 MEDICAL WASTE FACILITY <br />HER CLEANUP SITE (Not&LOP) Ell HOUSING ABATEMENT <br />ERGROUND TANK (MONITORING/REMOVAL) ['FOOD FACILITY <br />GROUND TANK lil CHICKEN RANCH/ DOG KENNEL <br />nAZARDOUS WASTE/HAZARDOUS MATERIALS Iii M EL/Horn <br />TIERED PERMITTED FACIUTY 00USPA <br />TATToolBoDY PIERCING rj COMPLAINT/RESPONSE RECORDS <br />I. 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 mall 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 />For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <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 />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 S130 deposit prior to rtiview. ***BOXED AREA. El-ID USE ONLY <br />V 6---)kve ovp9 Tf\s-twil refoils -tb kivrte-nr i <br />0 Records provided by Staff-PPR Complete. Staff Name: <br />to <br />SOLID WASTE FACILITY/VEHICLE Ei WASTE TIRE <br />LI DAIRY D WASTEWATER TREATMENT PLANT <br />LI PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />LI LAND USE APPLICATION SITES <br />El OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00Pm (EXCLUDING HOLIDAYS) <br />711/15