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AUG-14-2014 THU 09:23 AM Moore Twining Associates FAX N0, 559 268 7126 P. 02 <br /> DATE [ �f"�.+� EHD LOG NUMBER <br /> til <br /> �._ . SAN JOAQUIN COUNTY O <br /> iaCt ��Qjt. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Q <br /> Telepl a.tS-�-(209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> r�p am,a S 0jloi�JBLIC RECORDS RELEASE APPLICATION <br /> 'APPLICANT: BUSINESSIAGENCY: f'lcbr c 7-h ;.,•, �S.Sac:<�+ 7 ,c. <br /> ADDRESS: 25 27 Fie sno Skiee-r CITY/STATE/ZIP: esnv, eA 93^7e- <br /> PHONE(1): (SyY) 26 q - 70Zr PHONE(2):(5-5-4) `778-1115 -1/ FACSIMILE: &S-9) 26'0 - 712-6 <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 REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� �� �- ' DATE <br /> Electronic Information: ❑ List(] Map-Description: <br /> FEHD USE ONLY <br /> FILE ADDRESS <br /> Street# Street Name city ❑Unit 1 <br /> �' J <br /> 1. 135 r„1. ��.�v.-,��,..� �,-et� �-+ E' STdcGc�u r> 2Ie✓� <br /> 117 <br /> 2. v�arJ („J. Frey- c:�n - _S+rcc � �V S46c44-o �011V-1 <br /> 7��t � Unit2 <br /> . ° / <br /> 3. 2.�{S w F��.-�vr,.� cam.¢r.P�-�- sc-I*xGc�-� t <br /> 4 i�� I.J . rerw•ra S� eQ+ J ec1��� ��t�� .a'unit3 .�� <br /> ( 42 3 �✓.• /�'���->o., sf��.�t1n' $�0<4-J-v� . a urit4 <br /> 8K q 50 <br /> Unit 6 <br /> 9. <br /> 10. I r.-, Unit 6 <br /> Specific Date Range of information Requested: From to <br /> d:THER <br /> ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> DERGROUNO TANK(UST)CLEANUP SITE(LOP) L1i MEDICAL WASTE FACILITY SOLID WASTE FACILITY/VEHICLE <br /> ' CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> [y�UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY UP'IAIRY <br /> [}ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> VAZARDOUSWASTEIHAZARDOUSMATERIALS ❑MOTELIHOTEL ❑,(PUMPERTRUCKIYARDICHEMICALTOILETS <br /> IERED PERMITTED FACILITY ❑POOLISPA [v�LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING [ZCOMPLAINTIRESPONSE 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 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.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 /> 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. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. '"'BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete.Staff Name: <br /> 4128/14 <br /> Fun AR_na <br /> v <br /> Rar,, iar Tim,, dnn id I(11A O- IA6NA Nn h 1 <br />