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Lge: 2 of 2 02/17/2016 03:22 PM ' TO:12094640138 FROM: Genevieve Enriquez <br />PHONE 95104349200 <br />D��� SAN JOAQUIf� COUNTY EHD LOG NUMBER <br />MECENVIRONMENTAL HEALTH DEPARTMENT 17 <br />FEUD e 0 4u. 1$68 East Hazelton. Avenue, Stockton, CA 95205-6232 <br />elephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwv✓.sjgov.org/ehd <br />ISMRONm-efW <br />PERWIQTS PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �� QQSS <br />BUSINESS/AGENCY: M4 6S5VA� S%N\crt XT-'� <br />ADDRESS: +1�3 1E1�o�:�i�"e� INN;MS3,G, SriCet s CITY/STATE/ZIP: <br />PHONE (1): �GalO� ►{,1j'� `�LO� 5X4 �0� PHONE (2): FACSIMILE: b�%) <br />TENTATIVE* APPOINTMENT DATE: 'robRk� kCkAA\b Time: V-'bttm <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REO $125. E (ra:gH nR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE Z ji-1jn16 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street # <br />Street Name <br />City <br />�tNF,?A4- LAK%6 <br />stownew <br />,./� <br />�-LJ [Unit 2 <br />2. <br />3. <br />Unit 3 <br />4. <br />5. <br />❑ Unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />�7P <br />fli <br />Specific Date Range of Information Requested: From V5(AN Vt%tW(4 to btd� <br />ENVIRONMENTAL HEALTH DEPART v ENT FILES <br />MED <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ ICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLE <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />��UNDERGROUND TANK (MONITORINGIREMOVAL) 91- ❑ FOOD FACILITY ❑ DAIRY Z5_' <br />❑ ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT I-LANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALSO',,_ ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOISODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00Prvi (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) 464-0138 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 ofthe applicant <br />Future file reviews by the same applicant may require a $125 deposit prior to review. ff-fR7 7CED <br />Received Time Feb.17. 2016 3:22PM No.0487 <br />