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Lge: z of z 02/17/2016 03:22 PM TO:12094640138 FROM: Genevieve Enriquez <br />PHONE #5104349200 <br />101 <br />®�EHD LOG NUtJ�BER <br />D� SAN JaAQI!!f� COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />FED a oh 1868 East Hazelton Avenue, Stockton, CA 95205.6232 <br />UD e 0 40II?elephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvvww.sjgov.org/ehd <br />EWRO M''ENT-AL 1"6E141.'6'F <br />PF—Wrrt PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: PASS <br />BUSINESSIAGENCY: OF6�S\D 1, �s5$�(� `ttlkkS�f-iFi�, <br />ADDRESS: CITYISTATE/ZIP: OA,A\ <br />PHONE (1): �5�0� L6 t'' 'lM 5X6'bn PHONE (2): FACSIMILE: b�%) <br />TENTATIVEAAPPOINTMENT DATE: F6'buk?VA \R"m% Time: 04yy\ <br />(Please allow 10 business days from date of application submittal - `Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQ - 5125. E (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 2Iri f %- , <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />Street # <br />Street Name <br />City <br />e MW4- tA146 <br />4N <br />T <br />CVDIUnit 2 <br />2' <br />3.f,�t <br />'Unit 3 <br />4' <br />5. <br />❑ Unit 4 <br />6' <br />7. <br />❑ Unit 5 <br />8' <br />9. <br />L U-Iito <br />10. <br />Jr <br />Specific Date Range of Information Requested: From to ro <br />AE VI O REhTL HEALTHDEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLE <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE 1 r P,4 ",� <br />ji�ZUNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY ZS- 140 <br />❑ ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT i-LANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALSO',_ ❑ MOTELIHOTEL ❑ PUMPERTRUCKIYARD/CHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEP IC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PNl (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) 464-0135 or mail to the address indicated above Address <br />ranges will not be accepted - for additional assistance with file addresses, 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 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 />Future file reviews by the same applicant may require a $125 deposit prior to review. F3Q7CEt E EF Q USE ONL <br />9/4/12 <br />Received Time Feb,17, 2016 3:22PM No,0487 <br />