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o" DATE Sep• 11• 2015 2: 12PM <br /> SAN JOAQUIN COUNTY No, 1911 EhP• 13NUMBER <br /> Ifo® ENIONMENTAL HEALTH DEPARTANT <br /> :® 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ; <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: .r/16hy,+1 BUSINESS/AGENCY: S „1:10 � Pub C I LK,( <br /> ADDRESS: iIa& 1 a2 AVe— CITY/STATE/ZIP: S IOUC ��! CSS <br /> PHONE(t): nff4 1 Lf( —��,j PHONE (2): FACSIMILE: 209 q(,)g — ze,05 <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 R����E,�CASH f)R CHECK ONLY)-REQUEST PROCESSED IN 3�BaUSINESS DAYS <br /> SIGNATURE OF APPLICANT �f��[�(/�lrl DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD US �NLY <br /> Street# Street Name Clty vDatY1� L lC <br /> TDI-K GwC(w L'_ q'1 Vi✓ SVc"n Iveh �r✓t <br /> 2 3125' tr. -(Orn�t hauue_ D11ic Stuc; Mr ►t� -15 fu <br /> fel nit, <br /> 3. Wovuatm Dfl( & U!_V;J-a) "w Hw.r1(�-elJ Clew,-4e U- nit2 <br /> 4. 2q�� P�! - iM; waAq Dnve stuttNt ti v N e0 Lt,e,- r�UnitzH lob, <br /> 5• ?t {� Li �f . WI ln/a fvL pV 1VYr S�rN- t trwf <br /> 6. 32 2 -Tarn a4i a,WV_ Chi S cls Nr-N 9Unit3 <br /> T 32� ( �. Y1�al1GUa71G 1�(IV?i SD(�j�Yl Lo �2-Co01611t4 <br /> lapg, anvt, IUU__Tm tare L� <br /> s. 33 R N• IZ091�& all. 6 u "w1P - tL'�r r <br /> 10• 2 3 i �, v✓G(�tn IDSivCeaw, CD _Qp ®�it 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,UNDERGROUND TANK(UST)CLEANUPSRE(LOP) FR MEDICAL WASTE FACILITY SOLID WASTE FACILITYfVEHICLE <br /> OTHER CLEANUP SITE(NDN-LOP) S HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY DAIRY <br /> �]ABOVEGROUND TANK ®CHICKEN RANCH/DOG KENNEL M WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS ��❑7MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ••21 <br /> ©TIERED PERMITTED FACILITY POOLISPA ��-I LAND USEAPPLICATION SITES <br /> ❑TATTOO/BODY PIERCING 2 COMPLAINTIRESPONSE RECORDS g OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRmAY 8:00 AM-b:DOPM(EXCLUDING HOLIDAYS) <br /> 1. List uD to ten addresses in the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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. 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 /> 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 /> ce b° 0 3 I R CODu N til_in tic N U ?Ile to/ X601 tin 5106 <br /> (o A,W, COf90 o SS CO (AM &A COn 1111.) 4,tr jo Mwl 10,0 &A lu)I v1 "' Dr PSAek <br /> �t,ewl ord u +--.q7 y12 tr J 7.111 -Teo nrvJel {.Ile Vit, CO rie r ILA 2ti�7 <br /> _rf, ^^ 0---'-`- <br /> Received Time_Se , 22, _2015:. 2 : 09PM_N0. 9621 Staff Name: <br /> EHD"a G 7/1/15 <br />