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3Is U <br /> t3 DATE RI=CFIVED ::3-.-v -'; <br /> 9 SAN JOAQUIN COUNTY i7"U �-0. ALL:` ' �!EHD LOG NuMBEP <br /> Rf�Ci... V �� ENvukoi4mENTIAL HEALTH DEPARTMENT � � R <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 w <br /> SEP a 201 elephone: (209) 468'-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd '= <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> EWIRONMENTALIMALI H. <br /> 'Afl"MMRVj0l3 Racco BUSINESSIAGENCY: Live-Oak 'eoEnviranmental <br /> ADDRESS: VV_ CIMSTATEIZIP; <br /> • <br /> PHONE (1): f209)369-0376 PHONE(2): (209) 66-3222 FACSlMILF, 369-0377 <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 state and time to review the requ6sted records, <br /> ®CHECK BOX TO EXPEDITE REgLIE~ST-$134FEE !{OR CHECK OiJI Y)-REQUEST pROCESsEp IN 3 BLtSIh[ESS DAYS <br /> SIGNATURE OF APPLICANT Dt~.7E ca -3-! S <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS LHS USE ONLY <br /> Street# Street Name city <br /> ❑Unit 1 <br /> . <br /> 550 '.. W. Frewert Rd. <br /> it 2 <br /> 3. If4 r'� <br /> El Unit 3 <br /> 690 1 6fFJ-'Unit4 <br /> 7. a'b t.1 . I l�a {�- �r•.�� c,�C �_ R7 (`' : .0 ,, •�,lle4 OVJ(opiey <br /> -t- Cnh-, lir LXL llnif 5 <br /> 9. I t.eYs�. `�-t? �a'�� �r �r' .f-li 151rt•f= .c'r4 i-sC,�lt " <br /> ' I�YtJnit"6- <br /> SpeClf[c Date Range of Information Requested; Fi � �" to <br /> ENviRONMENTFAL HEALTH MPARTMENT FIL.ES <br /> UNDERGROUND TANK{UST}CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIIYEIl[CLE <br /> .OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTET;RE <br /> UNI)ERG120UNt1 TANK(MONr1411[NGjREmovAL) ❑POO[)FACILITY ❑DAIRY <br /> A60VEGROUND TANK ❑CHICKEN RANCH]DOG KENNEL ❑WASTEWATERTREATMENT PLANT <br /> HAZARDOUS WAST1=114-.—ZAP30US MATERIMLS ❑NIOTEi IHOTEL ❑PUMP <br /> ERTRUCKIYAR6/C hiErdlCkL Tt11LETS <br /> TIERED PERMITTED FACILITY ❑'POOLYSAA ❑LANO LISEAPPLICATION SITES <br /> TATTOOISODY PIERCING <br /> [ ComPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAiLAE:3LF FOR REVIEW; MONI3AY-FRIDAY 8:00 Am-5:04P47;(EXCLU©INC FEOLIDRYB <br /> 1. List up to to 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 Hie.type MUST be selected. Fax to 2 464.0138 or m to the addrass i ted above. Address <br /> ranges will not be accept&d.Applications receivod.after 3:00 pm will be processed the next business day, <br /> 2. For assistance In identifying the nature and content of EH[)records, please contact EHD.at the number noted above. <br /> 3. The EHD will notifythe applicant if any EHD files exist. An appointment for review will be�confirmed approximately tan (10) <br /> clays after receipt of application. The files will be held for a maximum of five business days for review. Appointmonts <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 exp®nse of the applicant. <br /> Future file reviews by the same applicant may require a 5125 daposlt prior to review. ��J03CED AR1 A-EHq tlSE.ONLY'�" <br /> rov,&e!l alp(, a•.J� R &u lti�^-rc G5 c7 of 14G rye s <br /> I U sys PL-%5 vUell`' at kr---P 41 I— /Z . <br /> ❑ Records praerlded by Staff-PPR Co riplete. Staff Namo: <br /> FHi7�.a-0a <br /> 4128114 <br /> Received Time Sep, 1 2015 10: 51AM No. 9483 <br />