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law Mar. 7, 2014 12:35PM Ao., 0334. K , 1 <br />■ S301Aa3S/1.IW83d <br />I� DAtd v-WN3wN0alAN3 <br />lillli SAN JOAQUIN COUNTY � G nruMqR <br />Ion' <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />COA13 ne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 'I I i.( 0- (~j• `s l i t ,�r + BUSINESSIAGENCY: , ! r C'_C 7 it - c�'4r�'t`j Ami <br />ADDRESS; A Z csC.) CITY/STATE/ZIP:�C.<-NF1 Ci <br />PHONE (1); i j (r,;�� i 8 'x; G PHONE (2): ! `( -1 (r. F,; (r; `-1 FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE:rr... e Time: <br />(Please allow 10 business days from date of applicati n submittal - *Tentative only - must be confirmed) <br />1'S ❑CHECK 130X TO EXPEDITE REQUEST - X125FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />t. <br />.e :� .SIGNATURE OF APPLICANT / � <br />x DATE Q _1 <br />Electronic Information: ❑ List ❑Map -- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />nit 1 <br />Street # <br />Street Name <br />City <br />1•14 <br />u, 0- <br />iMM coo` <br />befcr� 155 �bx r -!z. tscc�F ��` <br />❑ Un[t 2 <br />2. <br />L <br />ti r <br />+,i'1. ✓ _ �'`( .F�--t"'; <br />}-}�! � �,� <br />�',3 <br />3.4. <br />Il Unit 3 <br />5. <br />-� <br />jn it 4 <br />s' <br />7. <br />,E] Unit 5 <br />8. <br />9. <br />0�1Flnit 6 <br />10. <br />r7 <br />Specific Date Range of Information Requested: From 0V i L( to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />N UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ©.MEDICAL WASTE FACILITY D,SOLID WASTE FACILITYIVEHICLE Gy <br />[\],OTHER CLEANUP SITE (NON -LOP) Q HOUSING ABATEMENT Ej WASTE TIRE 7 <br />Q UNDERGROUND TANK (MONITORINGIREMOVAL) [:1 FOOD FACILITY ❑ DAIRY <br />[\ ABOVEGROUND TANK ❑ CHICKEN RANCH] DOG KENNEL Q WASTEWATER TREATMENT PLANT <br />RHAZARDOUS WASTEMAZARDOUS MATERIALS ❑ MOTELIHOTEL Q PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />TIERED PERMITTED FACILITY EIPOOLISPA LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING D COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (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 END 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. E"*BOXEp AREP�= EHl7`IJSE oI1L_Y <br />