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N08/06/2013 14:32 FAX 925 946 9968 ERM WEST WC <br />i. <br />PA ti SAN JOAQUIN COUNTY civ LO��IJMOER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />)UN (i 20');� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />S��r.IMI E T_elephone; (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />jP1 <br />P E M V I r f/SERV10E8 PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: l7eG BUSINESS/AGENCY: I✓ IleN'1 <br />ADDRESS: (01 -1 1 7n,A+ 810d, Ste S-00 CITYISTATE/ZIP: " (h,,,.,+ �.�LG (<T C14 q 15511 <br />PHONE (1): -1 d- 9 PHONE (2): FACSIMILE: q5,$ GJ YL erGr! <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />0 CHECK BOX TO EXPEDITE REQUEST- 25 F E (,CASH// ORS� CHECK _ONLY) -.REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT � C� DATE (I/L/ i 3 _ <br />Electronic Information: ❑ Llst ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />j Ut 1 <br />_ <br />Street a <br />Street Name <br />City <br />2. <br />19 _5_41 19 <br />12-14 <br />t061 <br />._ 0 Unit 2 <br />3. <br />Unit9, <br />4. <br />_ <br />5. <br />[-nit4 <br />6. <br />7. <br />❑ Unit 6 <br />6• <br />9. <br />❑ Unit s <br />10. <br />Specific Date Range of Information Requested: From Csle to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />&UNDERGROUND TANK (UST) CLEANUP SITE (LOP) u MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILIT`YNEHICLE I, , <br />OTHER CLEANUP SITE (NON -LOP) ❑HOUSING ABATEMENT ❑ WASTE TIRE t"I Q7/7i <br />UNDERGROUND TANK (MONITORINGIREMOVAL)'�- ❑ FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT` PLANT <br />AZARDOUS WASTEIHAZARDOUS MATERIALS_ ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED PERMITTED FACILITY ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />0 TATTOO/BODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RiEviEYY: MONDAY -FRIDAY 5:00 AM-5:OOPM (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_(20914B4-0138_or.mall to the address Indicated above. Address <br />ranges will not be accepted - for additional assistance with Elle addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notlfy 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 />3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br />submitted when the file is available. <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 />ruwre me rev,kews oy the same appucant may require a ���a aepo6lt prior review. ;gr ces}1;AML-1 iylR ,r;T{ <br />EHD 49-06 9/4!12 <br />Received Time Jun. 6. 2013 3:05PM No.3294 <br />