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° 06%2`5/2014 14:47 FAX � - � H Z002/002 <br /> �J�j Yn <br /> DATE RECEIVED c \' <br /> SAN JOAQUIN COUNTY FD <br /> VjE,CE "ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> AUG 2 QT4Qhone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd r <br /> ,,.h,i,,,AFNTALyiFAPUI3LIC RECORDS RELEASE APPLICATION <br /> �R`a <br /> APPLICA�TAM` q1 PI � BUSINESS/AGENCY: e Const. li^i <br /> ADDRESS: 332)3 S,R(Xv 0c S-}&_ 54)0 CITY/STATE/ZIP: IG•-.� O l a <br /> PHONE (1): PHONE (2): -)a 0 -J/{-O f3pR � 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, �1:eA <br /> Q:CHECK BOX TO EXPEDITER EST-5125 FEE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT . ..Q �(o DATE <br /> Electronic Information: ❑ Llst❑ Map-Descnptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name city ❑unit 1 <br /> "T 3 A)- I�tn.• ^ �-� �lAw. NM S M ffl*loVUnit 2 <br /> 4. <br /> Unit 3 Z <br /> 61 i u, , a , a , <br /> nit 4 <br /> 7. 11 <br /> a. , 11V <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> Unit 6 <br /> 3poelfle Date Range of Infornatlen Requested: From OD to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> r[rU�NDERGROUND TANK(UST)CLFANUP SITE(LOP) E]MEDICAL WASTE FACILITY [:1 SOLID WASTE FACIUTYIVEHICLE <br /> Ly)IHER CLEANUP SITE(NON`LOP) ❑HOUSING ABATEMENT ❑WASTETIRE / <br /> I���'arNDERGROUNDTANK(MONn ❑ <br /> ORING/REMOVAL) FOOD FACILITY ❑DAIRY �� <br /> [9ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL E]WASTEWATER TREATMENT PLANT "a��� <br /> [ 1AZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS lW' <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOMODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAJLASLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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)404-01313 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 files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The Flies 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 depoalt prior to review, ' EIQXED AREA-EHD USE ONLY" <br /> 2-1-)q <br /> Lt r. <br /> $ Slt,r 'SC l#T r <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD"a G <br /> 4/3EH! <br /> Received Time Aug. 20, 2014 1 :51 PM No. 6874 <br />