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AUG-14-2014 THU 09;23 AM Moore Twining Associates FAX N0. 559 268 7126 P. 02 <br /> �- <br /> ' r F ra.•S.^"•. <br /> DATE RI ► � E(',.1 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ;� 2Q14 ENVIRONMENTAL HEALTH DEPARTMENT pl7 f i <br /> !aUC. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 u (� <br /> T le f�o� (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> "tA1 p RiNtlfl -��1G%JBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGENCY: f"Acor-e <br /> ADDRESS: 25 2 7 F,.--,e snd S{.ee-r CITY/STATE/ZIP: !`;es•,v� c.q 93^7e- <br /> PHONE(1): <br /> 7ePHONE(1): (5 Y) 26 - 702-i PHONE(2): (5-5gl 278-`15141 FACSIMILE:&S9') 2,09 - 7126 <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 ar 1131,/1 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 135 I.J. F�e�-,ohs �,-ec + t�' S�o�k��.� 2IC.O1,,t <br /> v J P-017 Unit 2 <br /> 2 v�oZrj l..). Fie F-,on4- S+wee � �' ,S 46c4 -a,1 <br /> p � <br /> 3. 14 S l )rGr � / `t <br /> 4/ �-(O.� l.J . re.�.vr d- S 4-reQa- S of G�r�� �j I�I .fl Unit 31-;�t <br /> ' 142 /~10,a.'S m S+.epi 4-d t v Gc 4 <br /> 42 3 �✓.• /"��l:Jv.. SF��ast1�" S�.ptk-L, 0���� �C. Unit4 <br /> ;.fib 1 <br /> Cl 50 � CJUnit 5 <br /> 9. <br /> 10. I O'Gtte <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> kT`HER <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) L�MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE <br /> CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) El FOOD FACILITY RPPAIRY <br /> [}ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> [l IERED PERMITTED FACILITY ❑POOLISPA [LAND USE APPLICATION SITES <br /> F1TATTOOIBODY PIERCING tZCOMPLAINTIRESPONSE RECORDS ❑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 ten addresses in the space above. Seleetthe 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(208)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 /> ar2sH4 <br /> can AA_nA <br /> R0r01 ,oA Timn Aiio to AIA. Q- 14.04 NIn AAgl <br />