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EHD LOG NUMBER <br /> 5T--D <br /> SAN JOAQUIN COUNTY <br /> PT—5rI <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC 2 3 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:RI AI MM9tC Ib BUSINESS/AGENCY: C3��\SLP FtSSC(1�1ES1111G. <br /> ADDRESS: P.O. 3 b1C 33 CITY/STATE/ZIP: �VSG V 1L1 C <br /> FAX OR E-MAIL: Y' Ut Z\ bri1C(�1ASS�C\ASS• <br /> PHONE(1): �_�j 6A �1�%� PHONE(2): <br /> Please allow 10 business days from date of application submittal for the records to be available. LOVV\ <br /> Staff will contact you to arran `e an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE RE UES -,b1ZFEEAS OR C I CK , }t REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT :/ DATE 12 3 \l <br /> Electronic Information: ❑ List❑Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city 'tri <br /> 1. 32�� • CocM1s � D S(0( SoN 1 Tc ❑Unit 1 <br /> 2. 22�b� .• S �FWPI °\O\ SIA tz-D SToC�'(bN —N <br /> A� 5 J233 ' �.�M\S )?--VS .T\ V t� TI I,1Y✓1� /VtJ ❑Unit2 <br /> 4. 'L(b2% • s N 1�1NV%//% fp�o� � S [oc TbN �Ihlt►�M31� Ch4erY1 C ❑Unit 2H <br /> 5. 2 01 4 S 1�w %-1 'F- /c�t��y�/� Co <br /> lt3 <br /> <\�\, 6. S��i( �S�N lllrly,J (/t?Ut' 1 l/t/ Unit3HM <br /> 4: 3112 \,Q\A\ �D _ ,�� <br /> 7. ({f^ �yunit 4 <br /> �`� S "MN Y\ -Ml- �V , ITE MITIGATION <br /> B 2 1 OOM\5 1�b sToc CoN / {� <br /> 9. v✓ ❑Unit5 <br /> 10. <br /> to <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) El WASTE TIRE ❑DAIRY,POOLISPA <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑TATTOOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> ®TIERED PERMITTED FACILITY <br /> COMPLAINTIRESPONSE RECO RDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List ua 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. <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. <br /> ""BOXED AREA-EHD USE ONLY- <br /> 1171&SRI <br /> NLY- <br /> 282RI <br /> ❑ Records provided by Staff- PR Complete. Staff N me: <br />