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01/24/2013 11:11 4693851599 GAiATECH PAGE 01!01 <br />EHD LOG NUMBER <br />JA DATE RECEIVED SAN JOAQUIN COUNTY <br />`.r—N, ENVIRONMENTAL HEALTH DEPARTMENTr ;L1 do% 0# <br />�_--1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />9,4 Z01� Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov,org/ehd <br />I_NV1t ,GMMENTAL SEAL -f 11 <br />ISE jVICE PUBLIC RECORDS RELEASE APPLICATION <br />- s 13USINESSIAGENCY: <br />APPLICANT: ` -\_ <br />ADDRESS: Z �� �Q _)Cs �``��ATElZ1P: �V XZ� HO E y3 H ' Z- FACSIMILE 6�9�w <br />PHONE (1): �, Time: CkYv1 <br />TENTATIVE' APPOINTMENT DATE: -_�� - o .h�„IKa� _ •tentative only - must be confirmed) <br />Oil <br />(Please allow 10 business days from date <br />CHECK BOX TO EXPEDITE REQ ST - $125 FEE <br />SI NATURE OF APPLICAN <br />Electronic Information: <br />Ej Li <br />- Description: <br />ONLY • REQUEST PROCESSED IN 3 BUSINES DAYS <br />DATE\ I <br />Specific Date Range of Information Requested: From_1_ �I – <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />SOLID WASTE FACILITY/VEHICLE f <br />[� UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT WASTE TIRE C (I <br />OTHER CLEANUP SITE (NON -LOP) F1 FOOD FACILITY 1 <br />UNDERCROUND TANK (MONTORINGIREMOVAL) < ❑ DOG KENNEL ❑DAIRY tATM T L <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT <br />PUMPER TRUCIc(YARDICHEMICAL TOILETS <br />MOTELMOTEL <br />TIERED PERMITTED FACILITY Q LAND USE APPLICATION SITES <br />TATTOO/BODY PIERCING ❑ POOL(SPA <br />Q MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />1. List u to ten addresses in the space above. Select the <br />pe(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fa to (2091464-0138 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 w111 notify the app►icant If any EHD files exist. An appointment for review will b® confirmed approximately ten (10) <br />days after receipt of application. The files w111 be held for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />!.----A-- file that is actively being worked on-byEHD staff may not be Immediately available for review. A new application_tktay.11109—_. <br />submitted when the file la available. <br />Rece <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 daposit prior to review. <br />