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08l2u/2014 14 47 Fnx�� 00 <br />DII <br />DATE RECEIVED to a UMBER <br />SAN .JOAQUIN COUNTY <br />F(F,Cj�ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />AUG 2 OTIQhone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd r <br />......r9,AFNTp,LNEP,PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />q f o <br />FILE ADDRESS <br />BUSINESSIAGENCY: CON <br />ADDRESS: 33!)]) <br />S. <br />Rav%ock <br />�1 500 CITY/STATE2IP: <br />PHONE (1): la <br />O. 0633• <br />Q4 -n <br />PHONE (2): _)a 0 •14-0�r1�� FACSIMI <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 data and time to review the requested records. i i rI <br />CHECK BOX TO EXPEDITER EST- $125 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS Iz'cl 4(. <br />SIGNATURE OF APPLICANT( I (o- DATE <br />Electronic Information: ❑ List ❑ Map- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ unit 1 <br />Street 0 <br />Street Mama <br />City <br />G� <br />,y� <br />MMP i - Biu^CJ�P <br />h(A q S— i MM Unit 2 <br />�c osr a} 3 iiw Y <br />Unit 3 <br />3 <br />3_ <br />/7 <br />C C �. <br />^iia,,. �-�1 <br />nn j <br />C i) , .�� 431 <br />w.. <br />�9v <br />�" <br />i <br />nit4 <br />7. <br />- <br />❑ Units <br />8. <br />El Unit 6 <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES 4���'�' <br />[j;?LINDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACtUTYfVEHICLE <br />E?6TBER CLEANUP SITE (NON -LOP) ElHOUSING ABATEMENT ❑WASTETIRE <br />UEl <br />1-1 <br />UNDERGROUND TANK (MONrrORINGIREMOVAL) FOOD FACILITY DAIRY Vx1\)- <br />['ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT '�6.r} <br />EIRAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS p OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM•5:00PM (EXCLUOINe HOLIDAYS) <br />1. List up to ten addresses In the apace above. Select the type(G) of foes from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (20914640138 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 />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 flies exIaL An appointment for review will be confirmed approximately ten (10) <br />days after recelpt of application. The files will behold 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 .END USE ONLY^ <br />❑ Records provided by Staff -PPR Complete. Staff Name: <br />END 46-06 <br />Received Time Au,. 20. 2014 1:51PM No. 6874 <br />V=14 <br />