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DA-V a <br /> i 'j) EHD LOG NUMBER <br /> 'T 10 SAN JOAQUIN COUNTY 0 <br /> ,JUL 5 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �l6he-.-(209)468=3420-FAK:(209)464--GI3&Web:­Www.sj—gov.cTrg/elud <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: z-4-a Vt 0 <br /> ADDRESS: R-q fr,_eA CITY/STATE/ZIP: so i <br /> PHONE (1) PHONE (2): FACSIMILE: <br /> TEWTATIVE*APPOINTMENT DATE: time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> F-1 CHECK BOX TO EXPEDITE RE T-$125 FEE(CAC ECK71 -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT a?C DATE C7 13 <br /> Electronic Information: ❑ List[I Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name city E]Unit 1 <br /> 1. q L-0L_L7.k� <br /> 2. L-0dll 2Aj;_0 P6nit2 <br /> 3. <br /> 4. IdUnR3 <br /> 5. <br /> 6. IaUnit4 <br /> 7. <br /> 8. El Unit 5 <br /> 9. <br /> 10. YUnit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 MEDICAL WASTE FACILITY ETS—OLID WASTE FACILITYIVEHICLE <br /> ZOTHER CLEANUP SITE(NON-LOP) Ej HOUSING ABATEMENT ❑WASTE TIRE <br /> RtNDERGROUND TANK(MONITORINGIREMOVAL) [:1 FOOD FACILITY ❑DAIRY <br /> POVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HA7ARDOUS F]WAsTEfHA7ARDOUS MATERIALS [:]MOTELIHOTEL E]PUMPER TRUCKIYARDICHEMICALToILETS <br /> F-1 TIERED PERMITTED FACILITY E]POOLISPA El LAND USE APPLICATION SITES <br /> 7 TATTOO/BODY PIERCING F COMPLAINTIRESPONSE RECORDS F OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ton 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 mail 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 ton(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 /> .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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. **".BOXED AREA-EHD USE ONLY"** <br /> 0 Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 914112 <br />