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'N' 11/12/2014 10:56 91646446 SWRCE <br />I� <br />■ DATE R <br />I, ---\1E. SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />y_ Te.lepl gnrv-.:(209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />�lrf3?1A -- <br />APPLICANT: <br />ADDRESS: <br />PUBLIC RECORDS RELEASE APPLICATION <br />1!4, <br />BUSINESS/AGENCY: <br />CITYISTATEIZIP: <br />PAGE 01/01 <br />EHD LO(: NUMBER <br />PHONE (1): N, y(pj4__1T ' PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: $ Time:.` ,A -?- <br />(Please allow 10 bualness days from date of applicatiln submittal - •Tentallve only - must be confirmed) <br />❑ CHECK BOX70 EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS D SYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List []Map – Description: r S <br />FILE ADDRESS <br />EHC USE ONLY <br />unit 1 <br />Street 9 <br />Street Name <br />city <br />1. <br />-� 'f u <br />_ P �-q <br />r <br />11. <br />Unit 2 <br />2, <br />_ <br />22 221+ <br />tl f� <br />❑Unit a <br />4. <br />r—�----------- - -- <br />Unita <br />6. <br />7. <br />5 <br />L98,.Unit <br />Unit 8 <br />Spa fie Date Range of information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING AEIATEMENT ❑ SOLID WASTE FACILITY/VEI 91CLE <br />rl OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />❑ UNDERGROUND TANK (MONrrORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKNARDICHE'AICAL TOILETS <br />❑ TATTOOIMODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SI' ES <br />❑ MEDICAL WASTE FACILITY ❑ COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM -5:60 PM (EXCLUDING HOLIDAYS) <br />1. List up to On addresses in the space above. Select the type(s) of files from the list above by checking the appr( priate <br />box(es). At least one file type MUST be selected, F-aX to (209) 464-0136 or mail -to thp address indicated above. Address <br />ranges will not be accepted for additional assistance with file addresses, contact the EHD. Applications receiv :d 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 appmximat:ly ten (10) <br />days after receipt of application. The tiles will behold 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 appllcati on may be <br />submitbad 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 ap iplicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review, <br />EHD USE ONLY <br />aNn ea_na <br />Received Time Nov, 18, 2014 9:47AM No, 7572 8/1111 <br />