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DATE RECEIVED EHD LOG NUMBER <br /> SAN aIOAQUIN COUNTY <br /> �g ENVIRONMENTAL HEALTH DEPARTMENT <br /> t' d&�..,,J! <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> --- Telephone:(209)468-3420-FaX:(209)464=0138 Web: www.sjgov.org/ehd-4 <br /> APR 19 2013 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLTPXW..'PV1 VfN lAV4 �or_kI4 BUSINESS/AGENCY: /9e-T Co NScr Z 77.41-7- <br /> ADDRESS: 11 %j A/. 7/(4C5 6LLJO 112z 6 CITY/STATE/ZIP: Lg AC} 1 CA 953:4 <br /> PHONE (1): LgzS) Y8 7— 92 LI-7 PHONE (2): FACSIMILE: . <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK 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 <br /> ❑ Unit <br /> 1. I0 11/es1 Lahe S7ocKrev <br /> I <br /> 2. <br /> ❑Unit 2 <br /> 3. <br /> 4. 7 <br /> Unit 3 <br /> 5. „Il <br /> 6. <br /> 7 , Unit4 C51� <br /> 8. <br /> ❑ Unit <br /> 9. <br /> 10. <br /> ❑Unit6 <br /> Specific Date Range of Information Requested: From to <br /> ttvv�� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE j UA 3. <br /> �]UNDERGROUND TANK(MOE]NITORINGIREMOVAL)P ❑FOOD FACILITY ElDAIRY ° '/-j� f <br /> ABOVEGROUND TANK II77''nnll CHICKEN RANCH/DOG KENNEL [j WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS 4V— ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY 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 /> 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)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 /> 2. 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 scheduled accordingly. <br /> .3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available: <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$125 deposit prior to review. "'BOXED AREA-EHD USE ONLY' <br /> 7 awn 75 n v h IC ✓ 9 7 q 7 I/vQSf <br /> NRy 2ptsl�6 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHn 48-08 <br /> 9l4n2 <br />