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6/06/2013 14:32 FAX 925 946 9968 ERM WEST WC <br />�tat'6Ei 21 V SAN JOAQUIN COUNTY t LofrNUMeER <br />JUN 6 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />cA;l:'i7^?Telephone; (209) 466-3420 Fax; (209) 464-0138 Web: www.s19ov.org/ehdj1 <br />i�iEitiTo-" ?:�er;3_� J <br />FEm;Pc71 fI LFilliCy�;u <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: _Oe_ 7b; e W4 i,t BUSINESS/AGENCY: 2 IerV\ <br />ADDRESS: I P- i -) 7re,.g+ 81r,Q $ii SOU CITY/STATE/ZIP: W,J in o,.+ CrzG (< <br />PHONE L/$ )- " PHONE (2): FACSIMILE: ig,S - q yt, <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(PIOMO allow 10 business days from date of application submittal-'Tantati a only - must ba conflrmad) <br />El CHECK BOX TO EXPEDITE REQUEST- 25 F E (CASHH/ OR,, CHrgK-ONLY)-.REQUE$T PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT W "C' DATE G/L1 / 3 <br />Electronic Informatlon: ❑ Llst ❑ Map — Description: <br />_ FILE ADDRESS <br />Elio USE ONLY <br />`�/-1 ��\ ri <br />Street fi <br />Street Name <br />City <br />1. <br />2. <br />a2O500 <br />p//Ulatf <br />7j <br />Unit <br />3. <br />/❑ Unit 3, <br />4. <br />5. <br />D rinit a <br />6. <br />7. <br />EI Unit 6 <br />6. <br />g. <br />❑ Unite <br />10. <br />Specific Data Range of Information Requested: From Gi// to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />,UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON-LOP)_,i_� ❑ HOUSING ABATEMENT - C3 WASTE TIRE <br />UNDERGROUND TANK (MONrTORINGIREMOVAL)J ❑ FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK :'\. ❑CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENI PLANT <br />AZARDOUS WASTEIHAZARDOUS MATERIALS ��_ ❑MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTo1LETS <br />_j TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />TATTOO/BODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEW: MONDAY -FRIDAY 8:00 AM5:00PM (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 typo MUST be selected. Fax to (QB) 464-0136 or mall to the address Indicated above. Address <br />ranges will not be accepted -for additional assistance with file addrbasas, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHD Tiles 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 <br />Future file revAews by the same applicant may require a $125 deposit prior to review. <br />Received Time Jun. 6. 2013 3:05PM No.3294 <br />