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■ <br /> :■ DATE RECEIVED EHD LOG NUMBER <br /> I SAN JOAQUIN COUNTY <br /> -N RECEI OIJ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> MAR 2 6 2gifelephone: (209)468-3420 Fax: (209)464-0138 Web: www. ' ortht 0 q <br /> � IN�eFnITAL HEAI.TIi PUBLIC RECORDS RELEASE APPLICA <br /> �•..ppEE-RRMITISE%GES <br /> APPLTGANT:J r�,ppl�� BU SINESSIAGENCY:jPftej_0 P IN ' <br /> ADDRESS: 2-1-71 3�![LA RR INE CITYISTATEIZIP:Clav IS, CA 9 3 1�0J Z <br /> PHONE PHONE2): FACSIMILE: _ <br /> TENTATIVE*APPOINTMENT DATE: [0jjqTlme: <br /> (Please allow 10 business days from of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS D YS <br /> 01 SIGNATURE OF APPLICANT DATE f <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. tsgoo <br /> r fC `' <br /> 2. " V 'ff ❑Unit 2 ' <br /> 3. y v ; — J, <br /> Ni�` Unit 3 <br /> 6' _EIUnit4 <br /> 7 <br /> $' ❑Un" <br /> 9. <br /> 10. <br /> dUn it 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 FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) E]FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHDTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING TKCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the listabove by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contactthe EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> i <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for reviewwill be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a m mum 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 be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the appllcant.- <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. **`BOXED AREA-EHD USE ONL� <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 _ -----._._.—__ '!,` 914112 <br /> Received Time(M ar. 25. 2014 4;5 No. 5557 <br />