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EHD LOG NU%48ER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> RECD DEC 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT l <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �`�'�1�t1•,l�^ Telephone: (209) 468-3420 l=ax: (209) 464-0138 Web: �"wl.sjgov.orglehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AI/I( (Y— BUSINESVAGENCY: <br /> ADDRESS: (3(-oto ,S/i\UCZ A& CITYISTATEIZIP: I\'+;:,Vo JVV <br /> PHONE (1): � J6) �(Q ~ f 0 Z�' PHONE(2): FACSIMILE: <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 REQUE T-S130 F E(GASH//OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_ I r,L �t',(�e L'' �t DATE_(2— <br /> Electronic <br /> Electronic Information: ❑ List❑ Map—Description., <br /> FILE ADDRESS EHD USE ONLY <br /> I Street 9 I Street Name City ❑Unit 1 <br /> 2. (( Iq 2,1 ❑ Unit 2 <br /> 3. t rJ 22 aq(0 )', 142,a(ol) i ¢.2-7 o 106 <br /> 4. Q�t T►�^�Wt�� I( Z� I �OZj [Q/Unit 3 <br /> 5. I111rY ( � r l ' a <br /> 6. I O Un t <br /> 7. vaU3SGoa X54 /Zorn, <br /> g I ; []Unit 5 <br /> I <br /> 10. ElUnit e <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHIIC�LE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE � F ZIPS 15 <br /> fl UNDERGROUND TANK(MONITORINGIREIMOVAL),,�,- ❑FOOD FACILITY ❑DAIRY t (,O <br /> _ABOVEGROUND TANK -J- ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS FAATERIALS itk ❑MOTEL/HOTEL ❑PUMPER TRUCKIYA.RDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERU11T RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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(2091 468-0138 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. <br /> 3. Tile EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> (lays 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 S130 deposit prior to review. "'BOXED AREA-EHD USE ONLY— <br /> --0j / o / <br /> s <br /> g1N aT - d- LIZ <br /> Q Records provided by Staff-PPR Complete.Start Name: <br /> 08101114 <br /> EHD 48.08 <br />