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08/31/2015 1 : 49 : 24 PM –0500 FAXCOM PAGE 2 OF 3 <br /> i <br /> DATE RECEIVED ERD LOG NUMBER <br /> RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> AUG 31 ZQ151relephone:(209)469-3420 Fax:(209)464-0138 Web:wvaw.sjgov.orgland <br /> PUBLIC RECORDS RELEASE APPLICATION Ii <br /> f� fAtTQ�6FiRV �e (� gg t3WSINESSIAGENCY: CL?, —_ <br /> ADDRESS: ---3ZE) CITY/STAT;:JZ P! 5,4eG�*Jb"Jj.VQ 2! r ?y <br /> PHONE 1 : Lf15- f�Z7� T'3� <br /> ( ) ): nn r Wofy' ie' – FACSIMILE: fq/i- <br /> a c,6 i T C.ra r✓l <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will Contact you to arran n appolntm t d e and time to review the requested records. I <br /> ❑CHECK BOX TO EXPEDITE FiEQU 130 FEE(CA R K ONI -REQUE57 PROCESSED IN 3 D IN DAYS <br /> SIGNATURE OF APPLICANT _ DATE �' �f <br /> Eleatroniclnformation: 01ist❑Map–Description: ' <br /> FILE ADDRESS F1fo USE ONLY <br /> Street# Strast Namo city 0unit i <br /> 2. 30 Iq "v <br /> 4. 12/unit 3 �/ I <br /> 5' les, -a SITE MITIGATION (/ <br /> 6. ❑Unit 4 <br /> 7. q r <br /> 8• --- 1 a I7 Unite <br /> s. <br /> 10. --- ❑unit a <br /> Specifict3ma Reagoofinionnagnn Requested: From to <br /> Eh 01001C6e.ENTAL HEALTH DEPARTMENT FILES <br /> UNT)ERGROUNDTANK(US )GLEAAAIP SUE(LOP) D MEDICAL WASTE FACILITY ❑SOLID WASTE PAC(UrYIVEHICLE ! <br /> OTHER CLEANUP SITE(No*LOP) ❑HOUSINGADATEMENT ❑WASTETITE <br /> r'JUNDERGROUND TANx(MostiaRINGIREMOVAL) ❑FOOD FAciurY ❑DAIRY <br /> ASOVF.GItOUND TANK ❑CHCKEN RANC[d DUG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEfW.ZARDOUS MATERMLLS ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICIfENICAL TOILETS ! <br /> ❑DERED PERAMED FACIL1rY ❑POOLISPA ❑LAND USE APPLICATmn Styes i <br /> ❑TATT00/BODY PIERCING r]COMPLAIMIRESPONS£RECORDS ❑OTHER(PLEASE SPECAY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRinAY 8:06 AM-5:00PM(EXCLUDING HOLIDAYS) 1 <br /> i. List no M ten addreeaea in the space above. Select the ty j <br /> pa pe(a)of tiles from the list above by cFteeking the appropdate <br /> box(es). At least one file type MUST be selected. Fax to(208)484-0138 or matt to the address Indicated above. Address 1 <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next bus!noss day. ! <br /> 2. For assistance In identifying the nature and content of EHO records,Please contact END at the number noted above. 1 <br /> 3. The END will notify the applicant if any EHO files exist. An appointmentforraviewwiltheconfirmed approximatolylen(10) <br /> days after receipt of appileation. The files MI behold fora maximum of five business days for review. Appointments � <br /> should he schoduled accordinallY. <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 /> Potato file reviews by the same applicant may require a$126 deposit prior to review, "'BORED AREA-EHD USE ONLYA'* <br /> I_IS—tA to !C'XQSI L4.Nn Std <br /> ZILLuG21adC an� T✓J A/ n hJ _ r I <br /> ❑ Records provided by Staff-PPR Complete. staRName: <br /> the <br /> Received Time Aug, 31. 2015 11 :48AM No. 9444 <br />