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DATE RECEIVED <br /> U EHD LOG NUMBER <br /> SAN JOAQUINL�COUNTY ' . <br /> �!jj` ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' 205-6232 <br /> 1868 East Hazetton Avenue;.Stockton, CA 95 <br /> i <br /> Telephone: (209) 468-3420 Fax: {209) 464-0138 Web: www.sjgov.orglehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: E=rica Burkert BUSINESSIAGENCY. ECOLAB <br /> ADDRESS: 1601 West Diehl Road CITYISTATEIZIP: Naperville, IL 60563 <br /> PHONE (1): 630-305-2117 . PHONE (2): FACSIMILE: 800-724-9178 <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 REQ ST:-$130 F E(CAS OR CHECK ONLY)-' REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 05/21/2015 <br /> Electronic Information: ❑ List❑ Map—Descrl to : <br /> FFILE ADDRESS EHD USE ONLY f' <br /> Street# Street Name City ®!Unitf <br /> St.Joseph's 1800 North California Street 'Stockton <br /> - <br /> 2. <br /> IHOP 1150 East Yosemite Avenue Manteca ❑ Unit 2 <br /> 3. IHOP 3120 Na lee Road //� Trac <br /> 4. ""f A kc-j-` f."j ❑Unit 3 <br /> 5. U, <br /> 6. <br /> El Unit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH,DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) Q HOUSING ABATEMENT, ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINWREMOVAL) Q FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL [:]WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> COMPLAINTIRESPONSE RECORDS ❑OTHER PLEASE SPECIFY <br /> ❑TATTOOI130DY PIERCING ❑ ( ) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <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 1209)464-0138 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 /> t 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.-w ^ <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> i <br /> i <br /> 1 <br />} ❑ Records provided by Staff-PPR,Complete.'Staff Name: <br /> EHD 49-06 08!01114 <br />