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in From:5103383192 11/18/2015 15:00 9004 P.001/001 <br /> ■ <br /> ■ <br /> ■ DATE RECEIVED EHD LOG NUMBER <br /> �■ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> V'E , <br /> '� 1868 East Hazelton Avenue Stockton CA 95205-6232 <br /> 11%.e NOV 2G1� Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ENVIRONMENTAL t1r-j�'JU k �q <br /> )? b427 i � eA-A i2"V) BUSINESS/AGENCY: <br /> ADDRESS: �'=' ��Yef- CITY/STATE/ZIP: OC'WCLf')&� C/q 9.Lfo(�? <br /> PHONE(1): �ly` � jf PHONE FACSIMILE:CZ E1 - ► 2_ <br /> t 0`1 <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-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r DATE j ' k L ?) / I <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. SOU i l/c_C`S5 0 ")i C� � L I4t, o� <br /> 2. Tl -t 2_3 ` 1�V Y QS ❑Unit 1 <br /> 3, 21-{Sg;3 Soz��'!, C�sSO Pou�', I�ac.��- /vo �,I�t'Io -enitz <br /> 4. /�f <br /> ❑Unit 2H <br /> 5. } <br /> 6. <br /> --'Unit 3 <br /> 9 7. EY nit4 <br /> 8. <br /> ISYSITE MITIGATION <br /> 9. <br /> 10. <br /> ©'Unit 5 <br /> Specific Date Range of Information Requested: From _ to (k-& <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> EUNDERGROUNo TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY [� ID WASTE F�AnICILIT��EHIC E <br /> �ER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE 1 f <br /> ERGROUND TANK(MONrrORINGIREMOVAL� ❑FOOD FACILITY ❑j�Ai12Y ( 'i 5 i <br /> VA VEGROUND TANK D -1 CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> rRDOUS WASTEIHAZARDOUS MATERIALS E]MOTELIHOTEL El PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> IERED PERMITTED FACILITYpC ❑P OUSPA E�J-CAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING COMPLAINT/RESPONSE 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 fifes 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. f <br /> { <br /> 3. The EHD will notify the applicant if any EHD files exist..An appointment for review will be confirmed approximately ten(10) i <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 /> i}} <br /> y <br /> s <br /> f <br /> 's <br /> r <br /> 6--Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4M6 711115 <br /> Received Time Nov. 18. 2015 2:01PM No. 0045 <br />