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4UN/09/2015/TUE 11 38,2 FAX No, P. 001 <br /> EHD LOG NUMBER <br /> I[[a,TERECFIVE,D'„. SAN JOAQUIN COUNTY - <br /> [■[ <br /> '11 <br /> AN 0 9 !015 ENVIRONMENTAL HEALTH DEPARTMENT qp <br /> � <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTACTgtephbne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ?EPI+I?Il IglrRL°It','.�S <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Gl avl ' C-tOA r6tC <br /> } BUSINESS/AGENCY: <br /> ADDRESS: 1 � 5 /v Su f#ef CITY/STATEIZIP: STM, G!l ct57� 2 <br /> PHONE (1): 7_0q 5% 5qV) .PHONE(2): FACSIMILE: <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 ap intment date and time to review the requested records. <br /> 14 CHECK BOX TO EXPEDITE REQUESJyS93 �( � <br /> CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT DATE /OG �l�T7 <br /> Electronic Information: ❑ List❑ Map—Descrip on: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> A 516 V vl ej,17 <br /> 2. .❑Unit 2 <br /> 3. (J <br /> 4. /v� �r� �+11t5 ❑Unita )"7 <br /> ✓yYO SITE MITIGATION <br /> 7. <br /> 8, <br /> El 5 <br /> 9. <br /> 5.V10. unit 6 <br /> Specific Date Range of Information Requested: From Gt$ r as ass i < to I <br /> ENVIRONMENTAL HEALTH DEP RTMEN FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUNDTANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTFL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑PODUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REviEvv: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to tan 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 tho 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. <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$125 deposit prior to review. ”*BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> ERecei_ved Time=Jun. 9. =2015= 8: 54W--No. 8918 si79f1s <br />