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08/20/2014 14: 47 FAX41 <br /> pf 1`5SH EL /�Y <br /> DATE RECEIVED COUNTYSAN JOAQUIN <br /> � �jEIV s <br /> ENVIRO MENTAL HEALH DEPARTMENT <br /> q 1868 East Hazelton Avenue, Stockton, CA 95205-6232 n IL <br /> AUG 2 ft4Qhono: (209) 468-3420 Fax: (209)464-0138 Web: wvvw.sjgov.org/ehd <br /> ALHEAPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAW' 191CP 1-40 BUSINESS/AGENCY: � CCDV\st.UI{— L <br /> ADDRESS: .�3�3 S, ,�gv�vvot{c �}� 800 CITY/STATE/ZIP: <br /> PHONE (1): !a D- 0633- X034 PHONE(2): _)a 0 14-0 X509 3 FACSIMI : <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 /> ,QHECK BOXTO EXPEDITER EST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED INS BUSINESS DAY <br /> SIGNATURE OF APPLICANT( DATE <br /> Electronic Information: ❑ Llst❑ Map-Descriptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> f lt� Street E 1 Street Name City 0Unit 1 <br /> .J 1' A) H_ W�'9 9 .,n - MMP tWrAtq4niCC.7�P <br /> /��. Unit <br /> ` 7i <br /> 4. Unit 3 <br /> 15• L> <br /> Iq ' U) i ` f T3(}iLa} J��7i Cly J <br /> nit 4 <br /> T. `, ' <br /> 8. V ❑Unit 5 <br /> 9. C , <br /> Le <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From OD to <br /> I�-�� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ly 1 <br /> vNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYIVEHICLE �Jj c ! <br /> 216THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE L <br /> ['UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY Vc'' 1a <br /> ['ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL El WASTEWATER TREATMENT PLANT D <br /> g'HAZARDOUS WASTEMArARDOUS MATERIALS ❑MOTEUHOTBL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND 1.19EAPPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY•FRInAY 8:00 Am-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses In the apace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(ea). At least one file type MUST be selected. Fax to(209)464-0138 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 recelpt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be acheduled accordingly. <br /> 4. Any file not returned In the some 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 /> m <br /> Y <br /> GF 5 C L( <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD"e a M2N7� <br /> Received Time Au;, 20, 2014 1 : 51PM No. 6874 <br />