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om: Erik9iown - Fax: (888), 828.2635 To:12094640138@rcfax.cc Fax: +1209464013B Paget of 20611820156:23 AM <br />RECEIVED ... <br />.1 ,.. ..1. EHQ LOO NUMBER <br />DATE RE SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />.`'Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh.d <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT. Erik Brown BUSINESSIAGENCY: Partner ESI <br />ADDRESS: 520 Shelly Drive CITY/STATE2IP: Pleasant Hill, CA 94523 <br />PHONE (1): _(925) 262-8101 PHONE (2): (925) 305-5337 FACSIMILE (888) 828-2635 <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. Si OR CHECK ONLY) • REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />E.Let;;;nic Information: ❑ List ❑ Map— Descriptlon:__ <br />S" <br />s <br />[2. <br />1. 1301 East Loc <br />3. <br />5. . <br />6. <br />7. <br />9. <br />9. <br />10. <br />Speclne bete Range of f I matlon R <br />Street Mom i: city <br />St _ Lodi <br />From <br />to All <br />d .. <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ••�•' v ❑ SOLID WASTE FACILITYIVEHICLE <br />® OTHER CLEANUP SITE (ND*LOP) '❑ HOUSINGABATEMENT _ ❑ WASTE TIRE <br />®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br />® ABOVEGRDUND TANK ❑ CHICKEN RANCH/ DOG KENNEL <br />® HAZARDOUS WASTE/HA2ARDOUS MATERIALS ❑ WASTEWATER TREATMENT PLANT <br />Q TIERED PERMITTED FACILITY ❑ ❑ MOTEI./HOTEL ❑ :[I PUMPER TRUCKISITES L TOILETS <br />. POq-ISPA LAND USE APPLICATION <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS <br />❑ OTHER (PLEASE SPECIFY) <br />p11ELL I4ND SEpnC,PERMIT RECORDS ARE AYplLABLe,FpR REYEWp,,.,MonDpXrFRIDAlKB�Op AM 5:OQptN,(EMCLpDttt� NouD/1X....S) <br />1. Listuo to ten addressed in the space above. Select the type(s) of files from the list above by cheeling the appropriate <br />box(es). At least one File type MUST be selected. Fax to (209) 46x0139 or mall 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 Flies 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. t"BOXED AREA- PHn USyE ONLY*-- <br />Received T'� Jun, 18, 2015.. 6:23ANLNo.�.0,10 <br />