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FILE COP <br /> RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 5 2013 1868 East Hazefton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A&)-1I4�iI/f✓l!/�l�A� BUSINESS/AGENCY: E /lr/f/�!i'�J? �iFSdILG'<w <br /> ADDRESS: 1 W O 6L C4/J'2_T�6n5 ,4Y� zoDCITY/STATElZIP: S l[ctZ,t)y!! cyrJJ'D. q SS2 J <br /> PHONE(1): PHONE(2):6`f/ /, 7l6'%/S6 FACSIMILE: �W S7t�j�7 <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 D(PEDITE 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 0 Unit 1 <br /> 1. / N Yt/Ed7' /r✓E13�12 �z/E Sz' z��t/ <br /> 2- /.5r'2/ /lie �� r/ Unit <br /> 3. <br /> 4. Z R �� nit 3 <br /> 6. i;1 �j on/ ?41JK- <br /> 6. ❑Unit4 <br /> 7. <br /> 8. 0 ICU <br /> Unit 6 <br /> 9. <br /> 10. ❑Unit 6 <br /> iSpecific Date Range of information Requested: From to <br /> ,,,,__ <br /> ,,,,(( ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1!? NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FAGLffYNE I(CLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> El \\u\j <br /> UNDERGROUND TANK(MONnORING(REMovAL) ❑ ❑DOG KENNEL DAIRY <br /> El HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT P <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTGo1BODY PIERCING ❑POOLiSPA El LAND USE APPLICATION SITES <br /> [:] MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS El OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY8:OOAM-i:OOPM(EXCLUDING HOUDA S) <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 mall 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 behold 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,ba <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 review&by the same applicant may require a$125 deposit prior to review. <br /> EHDUSEOMY <br /> f4Q410-Q42 Cd� ; <br /> 2 <br /> EHD 48-08 8!7!11 <br />