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DATE RECEIVED <br />LA ( SAN JOAQUIN COUNTY <br />6305 r`P ENVIRONMENTAL HEALTH DEPARTMENT 1.k... <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/end <br />PUBLIC RECORDS RELEASE APPLICATION <br />END LOG NUMBER <br />cgçlV <br />APPLICANT: 3 e... Cor-01 6(1_ BUSINESS/AGENCY: %Bel.' <br />ADDRESS: • • Yr), CYO- JDO-01 . CITY/STATE/ZIP: /Trod I (.20 R*0 Slit b <br />PHONE (1): .3o 3‘ „la _ PHONE (2): FACSIMILE: 303 —ga — 0 I 314 <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 • MD FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT 6 A6e.."_--- DATE <br />Electronic Information: III List EA.r tiori: <br />ADDRESS <br />EHD USE ONLY <br />. Street # <br />ic9 8 0 0 <br />Street Name <br />1,4 FILE 0 ri, h T <br />BOO 10.4,Q0-CL <br />. City <br />Trb-cy <br />q S 516 <br />2 1-} A 1 15 a Unit 1 <br /> <br /> <br />El Unit 2 <br /> <br />0 Unit 2H <br /> <br />0 Unit 3 <br /> <br />A 0 Unit 4 <br /> LI SITE MMGATION <br /> <br />ID Unit 5 <br />acific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />to <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) III MEDICAL WASTE FACILITY <br />HER CLEANUP SITE (NoN•LOP) 0 HOUSING ABATEMENT <br />ERGROUND TANK (MONITORING/REMOVAL) 0 FOOD FACILITY <br />GROUND TANK 0 CHICKEN RANCH/ DOG KENNEL <br />nAZARBOUS WASTE/HAZARDOUS MATERIALS 0 M EL/HOTEL <br />TIERED PERMITTED FACILITY 00L/SPA <br />TATTOO/BODY PIERCING [1] COMPLAINT/RESPONSE RECORDS <br />LI SOLID WASTE FACILITY/VEHICLE <br />CI WASTE TIRE <br />LI DAIRY <br />LI WASTEWATER TREATMENT PLANT <br />LI PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />LAND USE APPLICATION SITES <br />LI OTHER (PLEASE SPECIFY) <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 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 re-organized by EHD staff at the expense of the applicant. <br />4(-Ptve apt) f 44\31/attil )-eforts. 11 lidurwil akliC <br />CI Records provided by Staff-PPR Complete. Staff Name: <br />Future file reviews by the same applicant may require a $130 deposit prior to rifOriew. "'BOXED AREA - END USE ONLY <br />7/1/15