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07/RE29/2/ SAN .IOAQUIN COUNTY <br /> 015 1 : 21 : 11 PM -0404VAXCOM ANYWHERE • PAGE 4 OF 4 <br /> (CEIVED EHD LOG NUMBER <br /> V Y <br /> JUL 212015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRCt4MEt4TA@.HEIT4Mphone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br /> wERrtTlsSWAS �✓PUBLIC RECORDS RELEASE APPLICATION �( f <br /> APPLICANT: ( wry ) tu, ti- BUSINESSIAGENCY: Fir <br /> ` tt tt hu,ronw�e.r. a c. <br /> ADDRESS: �j`fLYJ �nnwld5 PJf�dt t {✓!e a17C7 CITY/STATE/ZIP: ROU'A�, a .75 as/ <br /> PHONE (1): CJI ZL_.- PHONE(2):e[4� -7,� 7 z FACSIMILE: 93-2-19`1- 62 <br /> 7S <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 REQUE T-$130 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 71I <br /> Electronic Information: ❑ List Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> Y I <br /> _.........................:........................-............... <br /> / ?..... <br /> 1. W5 15 i<1 _0oro.c(( 5_ Ix3 <br /> 2. �1 I✓ udt0 L K G 3� x�ili7 t(!? Q ❑Unit, <br /> 3. LLnn I_l .... / <br /> 4. W �' ❑Unit 2H <br /> 5. <br /> _ .......__..............-. <br /> B. vl dei a (m Unit a <br /> .............._._.. ................................---- <br /> 19 <br /> 7. i"'1 17`1nit4 <br /> --........................... ........... <br /> t?,2j`!r[TEmrnGAR0N <br /> 9. <br /> 10. pUnit 5 <br /> Specific Dale Range of Information Requested: From to <br /> ���,,,,,,{{{ - - <br /> ENVIRONMENTALHEALTHDEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(Nowl-OP) I ❑HOUSING ABATEMENT WASTETIRE <br /> �tUNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> �y ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA E9 LAND USE APPLICATION SITES,., <br /> TATTOO/BODY PIERCING �COMPLAINTIRESPONSE RECORDS 9 THER(PLEASE SPECIFY)�OtJ1l 4'5`)f' (( <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. k F <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 /> t7Jta " fC .� Cor Its aril t -10 tA. IIA0+'ulCk 5106 re ,l-t r w�,-(- OAbI(I <br /> ❑ Records Provided by Staff-PPR Complete. staff Name. <br /> Received Time=Ju 1. 29. =2015=10: 20AM--No. 9221 VVIS <br />