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DAT1Se,p. 22. 2015 2: 13PM No. 1911 EIP. 40NUMBER <br /> ' N ENVIRONMENTAL ONMENTAL HEALTH DEPARTSAN JOAQUCOUNTY MENT <br /> OCT 14 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> EE VIRONMENTALriEALT[i PUBLIC RECORDS RELEASE APPLICATION <br /> Rrne mrleLALHFPa <br /> APPLICANT: f �'' 1. MC�IY)(7lC BUSINESS/AGENCY: Court, 1—j,�tG WO� <br /> ADDRESS: ��li\� �. 44art tpn Ay'e . CITY/STATE/ZIP: 9Gfoirn 01 G1J2C�� <br /> PHONE(1): PHONE (2): FACSIMILE: 6-q { 4(pg—LgCtq <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- 131 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SrEleSIGNATURE OF APPLICANT �(/+y( (/�_( DATE I^(s- <br /> Electronic <br /> ctronic Information: [:] List❑ Map—Description: <br /> FILE ADDRESS <br /> Street Street Name City EHD USE ONLY <br /> 1. `J�ipS F2• VA WAYJ4 Drive' Slv� (�Yl w NNrpP—oD <br /> 2. C2"���� <br /> Unit 1 <br /> 3. <br /> �unle2 <br /> 4, Lyp/unit 2H <br /> 6. <br /> nit 3 <br /> 7. ®Unit4 <br /> F;. <br /> Bd SITE MITIGATION <br /> 9. <br /> 70. <br /> �lJnl!5 <br /> Speclflc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I�p'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) a MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE <br /> 10 OTHER CLEANUP SITE(NON-LOP) ®HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY DAIRY <br /> ABOVEGROUND TANK 'CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> IHAZARDOUS WASTE/HA2ARDOUS MATERIALS ❑MOTELIHOTEL ,PUMPER TRUCK/YARD/CHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ®POOUSPA LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING 0C MPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAYS:OO 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)404-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted.Applications received after 3:D0 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. <br /> 3. 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 sched-lad 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 /> 10 <br /> n0--_�-�_ Staff <br /> Name: <br /> Received�Time=Sep. 22. _2015= 2: 09PN1-No. 9621 <br /> EHD 4806 <br /> 7/t/16 <br />