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W PR -22-2015 11:53 FROM: T0HH & r ITRY 2093695859 4F401^9 P.1/1 <br />■ <br />1 ■ <br />1% DATE_ RECEIVED EHD LOG NUMBER <br />1 ■ SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPAR'fNRENT lobs <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />/jr <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: � � �� S / �e� BuSINESSIAGENCY: / _5_ <br />ADDRESS; L-,) CITY/STATE/ZIP: <br />PHONE (l ), ) ?,--,4�PHONE (2a LZO �0� FACSIMIL �� �ip <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 - FEE CASH OR ECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT - ®ATE � ®�� p,® <br />Electroni.c Information: ❑ L_' Map - Descri ion: <br />FILE ADDRESS <br />-� EHD USE ONLY <br />❑ Unit 1 <br />Street <br />Straet Name <br />City <br />1 'j <br />! <br />!J <br />0 <br />ISA < ❑ Unit 2 <br />2.�G <br />� U B®s <br />3. <br />El Unita <br />4 <br />�e. <br />F]'Llnit d <br />8• <br />7. <br />P�a� �Xd tS 4^ <br />1 ►^^► ,— _14nit 5 <br />fR <br />14 �AA'5 ❑ Unita <br />8. <br />- _ <br />9. <br />10. <br />-- --- <br />Spocifie Date Rang® of Information Requ©st©d: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILETS <br />eRROUND TANK (UST) CLEANUP SITE (LOP) ❑ ME AL WASTE FACILITY ❑SOLIO WASTE FACILITYIVEHICLE <br />CLEANUP SITE (N9N-LOP) BUSING ABATEMENT ❑ WASTE TIRE <br />ROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILIT( ❑ DAIRY <br />E®ROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ® WASTEWATER TREATMENT PLANT <br />AZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ PO PA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOiBODY PIERCING OMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />_WELL. AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: IVIONDAY-FRIDAY 8:00 AM -5:001"M (E:{CLUfDINo HOLIDAY( <br />1. List uta to ton 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 Elle type MUST be eelected. Fax to (298) 464-0138 or mail to the addreas Indleated 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 EH® will notify the applicant If any EHD flies exist. An appointment for review Will be confirmad approximately ten (10) <br />days after receipt of application_ The files Will behold 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 fila reviews by the same applicant may require a $130 deposit prior to review. `"BOXED AREA - EHO USE ONLY'`` <br />�fit,1i ��� Lc� <br />ta�-ic i/r" <br />n Irl Ccs <br />_EI 11ecards .provided by Staff -FPR Complete. Staff Nags:---- <br />cnu _7 <br />Received Time Apr.22. 2015 11:59AM No,8576 <br />Deroii1n <br />W <br />