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■ <br /> •■ DATE RECEIVED SAN .1OAQUIN COUNTY EHD Logi NUMBER <br /> l f <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> MAR 2 6 2014Telephone: (209)468-3420 Fax: (209)464-0138 Web: www. ' itet o , <br /> fll <br /> ,R�nldnnENTALHEALTH PUBLIC RECORDS RELEASE APPLICA <br /> APPLTGAN S`j30&' CxWDINEs BUSINESSIAGENCY:-PIPIP170ap-R IN W7 <br /> ADDRESS: 2-1-71 3�[LW AR INE CITYISTATEIZIP:C,(aj IS, CA 9 6J Z <br /> PHONE (1): 7._( 7,2 SPHONE 2): FACSIMILE: _ 0 <br /> TENTATIVE`APPOINTMENT DATE: (Q f Tlme: <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 /> SIGNATURE OF APPLICANT DATE J <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2' 4 [I Unit 2 <br /> 3. y v tet, `, <br /> 4. <br /> it 3 <br /> Un <br /> 5. I ',y <br /> s' .ElUnit 4 <br /> 7. <br /> $' ❑Un' <br /> 10. / vv/ <br /> I]-Unit ti- <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 FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MOWORINGIREMOVAL) ❑FOOD FACILITY F]DAIRY <br /> ABOVEGROUND TANK Q CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE(HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING TKGOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 13:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the 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 /> 1 The EHD will notify the applicant if any EHD files exist. An aplbointment for reviewwill be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a rn2 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 /> submltfed 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 applicant._ <br /> Future file reviews bythe same applicant may require a$125 deposit prior to review. *' BOXED AAEA-EHD USE ONLY <br /> ❑ Records provided by Staff-PPR Complete, StafName: <br /> EHD 48-06 - - <br /> -. 9/4!12 <br /> Received Tim eMar. 25. 2014 4:58PM, No. 5557 <br />