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10001J 1/ZJ/2UL4 WED 15: 03 FAX 2099235960 Cannon C9075 2001/001 <br /> I � <br /> tn EHD LOG NUMBER <br /> ,�� EIV GDSAN JOAQUIN GOU <br /> V qW <br /> JUL 2 3 2014 ENVIRONMENTAL HEALTH DEPARTMENT n <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 k <br /> Telephone: (209) 468-.3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> Pr:PRAiT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> 11 � NA 11 ' 1 L <br /> APPLICANT: �S OF �( �i,DItGtY1VYIGY� G <br /> USINESS/AGENCY: bj 0 � MA"h_GA <br /> ADDRESS: _ QQ�1� . G /�/ �{. CITYISTATE/ZIP,May4e a i GA Q <br /> PHONE (1): 145(p-!Z j j PHONE(2):_1451p 011) FACSIMILE: D <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 RE/QYFST-$125 F�EESCASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSDA S <br /> SIGNATURE OF APPLICANT ( v. CisLG ./ L Y !, -' iC. DATE 3 / <br /> Electronic Information: Llst❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street S Street Name City Unit 1 <br /> 1. J11r <br /> 2- - F Unit 2 <br /> 3. <br /> 4, � . J.: C ilCi r. <br /> Unit J 7 <br /> 6. f1r <br /> 6. Unit <br /> 7. <br /> El Unit o <br /> 9. <br /> 10. .-.^- ; 6Unit6 <br /> Speclflc Date Range of Information Requested: From to <br /> ,�J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY .PISOUD WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑Hous Na ABATEMENT El WASTE TIRE <br /> [UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FoOD FACILITY ❑DAIRY <br /> QcVEGROUND TANK El CHICKEN RANCHI Doe KENNEL El WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WAsTEIHA2ARD0US MATERIALS ❑MOTEUHOTEL E]PUMPER TRucK/YAROICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCINO ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 0:00 AM-6:o0PM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses in the space above. Select the type(s)of 1`1 lea from the IIsi above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(206)464-0138 or mall to the address Indicated above. Address. <br /> ranges will net be accepted.Applications received after 3:D0 pm will be processed the next business day. <br /> 2. For asslatance in Identifying the nature and content of EHD records,please contact F_HD at the number noted above. <br /> 3. The EHD will notify the applicant If any EHO.RIes exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 EHID staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$126 deposit prior to review. "'BOXED AREA-END USE,ONLY^" <br /> ❑ Records provided by Staff-PPR Complete. Staff Name! <br /> Ego 4126114 <br /> Received Time Jul, 23, 2014 3:06PM ido. 6670 <br />