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RECEIVED : i EHD LOG NUMBER <br /> AN JOAQUIN COUNTY <br /> ENVIRWMENTAL HEALTH DEPARTMENT <br /> /rte 1868 East Hazelton Avenue, Stockion, CA 95205-6232 7 <br /> 02—15 <br /> Telephone• (209)468-3420 Fax: (209)464-0138 Web:www-sjgov.org/ehd / <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 1PPLICANT: Mb&,, P'app W6 BUSINESS/AGENCY: <br /> \DDRESS: 4 ? I S�P�,Mf I )�, CITYISTATE/ZIP: Ci.0y1,1,_C A 9 �Z,F I <br /> 'HONE(1). t,;S(?, (�S-7. i•7` Z PHONE (2): 56j. 3 2 FACSIMILE: C:7S1I-5L47 • blfb <br /> TENTATIVE`APPOINTMENT DATE: sif! Time: <br /> (Please allow 70 business days from dat of iipplication submittal--Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR C K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city unit <br /> O O <br /> 2• ( 3 ❑Unit 2 <br /> 3. G <br /> onG� <br /> �4• ❑Tnit 3 <br /> PV 5 �f <br /> 6. j3lJnit 4 <br /> 7. <br /> 8. 0 Unit 5 <br /> 9. <br /> 10. B Unit6 <br /> ipecific Date Range of Information Requested: From to <br /> ! ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FAcCRJTYNEHICp��E / _ •� <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT N WASTE TIRE 0 f l)P5 I'I'I- l A i I <br /> UNDERGROUND TANK($yl•ONITORINGIREMOvAL]f( ❑FOOD FACILITY ❑DAIRY V471/" <br /> Yi4 _�._l '-(3 <br /> ABOVEGROUND TANKrt``�.� ❑CHICKEN RANCH/D00 KENNEL ❑WASTEWATER TREATMENT PLANT '1 <br /> HAZARROUs WASTEMAZARDOUS MATERIALS ❑MOTELIFIOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ,TIERED PERMITTED FACILITY '� POOLISPA ❑LAND USE APPLICATION SITES <br /> ]TATTOOIBDDY PIERCING 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 /> I, List uo to ten addresses in the space above. Select the type(s)of flies 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 /> '. The EHD will notify the applicant if any EHD flies 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 /> L A file that is actively being worked on by EHD staff may not be Immediately available for review. Anew application maybe <br /> submitted when the file Is available. <br /> •. 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 revIewAs by the saipe applicant may require a$125 deposit prior to review. 'AA �1 <br /> . ^."i x,+.., t 3', x: - .f 5�h -��..._xr `y 'k ,ut w `.y'� _ t '<;'✓iiy <br /> t �� nH .' -:u �'r:. �'_: rti ",. �✓ F.''�•'� A SY.: -"c ��/ ''' `"- '� SI' e <br /> .0 vu ° .. . .. ' ..• 1 -T ' .. ...:Ate- w rJ3�l;.fan.. m s :. t ,. " " r ' -.ss .. .P.'". �I.•"'."r ,caber''•. <br /> b•-1 a ep)x S _ Mho ) -Cc'�� <br /> Ho-as-ss � - r (e- 157&6D Yt,rae? p4l) (0-59 <br /> Received Time May. 22: 2013 1 : 18PM No, 3161 n <br />