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04/28/2015 4:23:56 PM —0400 FAXCOM ANYWHERE f` PAGE 3 OF -3 <br />IQ�EE'. SAN JOAQU`IN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />APR 29 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvAv.sjgov.org/ehd <br />r=t�vli�O�nFLii%aL� t�r�lrl-E <br />PI-TV1TISFSVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: MAEIL !GD,,,jAr >S BUSINESSIAGENCY: <br />ADDRESS: (l } CITY/STATE/ZIP: <br />PHONE (1): PHONE (2): FACSIMILE: <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUEST- $ l3f7 FE (CASH O CHECK ONLY) -REQUEST PROCESSED IN 3 B,UrST ESS1iDAYS <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street# <br />Street Name <br />City <br />1. <br />'4 ((J <br />kin t` ter <br />❑ Unit <br />2. <br />L� 73 <br />Q,3 <br />nr J <br />�jV_t� <br />�l� lJ�u—`YY a YU�T'J <br />���:ry {�1 <br />3. <br />-�Z-,eo <br />r <br />Q Unit 3 <br />4.CL <br />L-f—It <br />6-0t�aut t� G ��w6w ll— El Unit 4 <br />6. <br />((� <br />(� f%2.�1✓I " j .A D <br />`T�C�TaJ'\1 <br />7. <br />i ``i <br />❑Unit 5 <br />8. <br />9. <br />IiVe* 112 Calp.e�. <br />El Unit <br />10.yj <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />INDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SSOUD WASTE FACIUTYIVEHICLE <br />THER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEMAZARDOUS MATERIALS ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY U POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATToo/BODY PIERCING ZfCOMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-S: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 (209) 464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. 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 />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 $130 deposit prior to review. '*`BOXED AREA - EHD USE ONLY*** <br />t� <br />p��`�'-'r��,�.Ino r`:Z" 9kf2t° �p� <br />1o�11A!k ` a- oz, r -f- ph &'r Iti �6tA6 cr /\s <br />❑ Records provided by Staff -PPR Complete. Staff Name: <br />Received Time Aar. 28, 2015 1:23PM 1tio. 8594 OM1114 <br />t� <br />