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DATISep. 22, 2015 2: 12PM No. 1911 EVP. 23 NUMBER <br /> i SAN �IOARU{N COUNTY <br /> V1a(2SSG� cN; EARONMENTAL HEALTH ®EPARTINT <br /> 1868 East Hazelton Avenue, Stockton, CA 95206-6232 <br /> �0� ICj Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> f�1 ! PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ff' I4w M cd((Anl, BUSINESSIAGENCY: ETOU22 R001161 WD <br /> ADDRESS: IRio .F- CITYISTATE/ZIP: STx�, ,+ �T52os <br /> PHONE (1): (20cl) LFA K -�O PHONE (2): FACSIMILE: (ZE) q(oy- 'Zetem <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"-�$�13300 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �(/I/le�/�,_4 �' /`'lh DATE -Z{l <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Sre <br /> tet# Street Name city <br /> 1. 3 59 0 F- C-KM�_&_ P_acc G t�Ihc�' Ham-�a IHr ^�I cA,cl,�Y ,-COP) <br /> 2. `2� 5 iJ- 7�(Orne� Grrfu l 1 `t Cl/--W) I tr�w1P f 2 c+� �ke�fz-c� ®u it 1 <br /> 3. -'Z.'Z N Yp OvI Wl E_' Vck-TDt �(y`J�����,-0 wuU'it2 <br /> 4. �j(� IJ, l (jfgcl 6 1E�b`i V) 9_15 5-t" 0-Linit2H <br /> tG�IG <br /> J 5• 2��15 N, rtaeze- Ph g1b C,(/__Jun NMMn-�D <br /> 6. 2 L'A4 C"-P L0 UUnit 3 <br /> 7. "2,(G SD N , l�Mn �I. W R� ori trG S v C�)Yl Hwy xz-cp �ra7.-c0 ;X1 <br /> L 15D `�'"�r '�• �� &���q NC{ L�YSITE Mg 3201 r. UUnG� brlI t S'TDCtr� taMr,p-c0 n�u11a131uc <br /> 1o. /wii N . Wi ivary, Pnk DD(r -ran ivf'iz� Obw, ®unite <br /> Specific Data Range of Information Requested; From to 0-13-Gi <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) -MEDICAL WASTE FACILITY ®SOLID WASTE FACILnYNEHICLE <br /> 120THER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT UWASTETIRE <br /> RbUNDERGROUNDTANK(MONRORING/REMOVAL) FOODFACILITY DAIRY <br /> .�/ ABOVEGROUND TANK 91 CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WAs'TE/HAZARDOUS MATERIALS E]MOTEL/HOTEL �](: PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY Z POOL/SPA LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ®.COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:0D AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo 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 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 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$130 deposit prior to review. "`BOXED AREA-EHD USE ONLY' <br /> %i,A4lAW0ie.6r 35010 C4-M(ee Jwc)• (OJth4 UrAm (•ilk r 3S010 CLerA[02 37A1 L, A, P 115 kA )114h5 <br /> te' w w, ')_G-o "I tiK ca. AoJS¢9, (.o!.I WvA-5 W 6400000�y73S C7 a�tt�yq v JLL cA. <br /> J �$ I�vt v (o �u SIO(o y n9uY�eJ. GL.e Qe tart d••n r a0 Ll,greii w„R Z S Tee <br /> n o........t,. .�rr...:.+...� t0,. 'ifc nno rO­r_<_ Staff Name: <br /> Received Time=Sep, 22. _2015= 2: 09PM_No. 9621 <br /> EHD 46-06 711115 <br />