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JHrN- 't—LOID 1U:11H rru1'l:1otUl-HHbt ENV TO:46.10130 P.2 <br /> - EHD LOG NUNIBER <br /> d (• ;' " SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT it <br /> JAN �t 2015 1868 East Hazelton Avenue, Stockton, CA 95245-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br /> E10a9NMENTALHEAIn- <br /> PkRMIT/SE9VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_�e4le 14r�n BUSINESS/AGENCY:_ / � y <br /> ADDRESS: 27 -if e/t• r A✓e- CITY/STATE/ZIP:—Z rv�,!S7?1 2! 7S-a <br /> PHONE(1): PHONE(2): FACSIMILE: ]' <br /> TENTATIVE¢APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application aubmlttal- Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CA OR C CK ONLY -REQUEST PROCESSED IN 3BUSINESS DAYS <br /> SIGNATUIRE OF APPLICANT QATE--� /S <br /> Electronic Information: ❑List❑ Map–Descrip on: <br /> FILE ADDRESS EHD USE ONLY <br /> Stree td Street Name City ❑Unit 1 <br /> 2. 1 _. -- -- ©Unit 2 <br /> 3. t t ii <br /> 4. / ;� J ..�-Lr ,+r'il( Ef�fr�_.rr(: "r1 _ , ✓-- Unit3 ^f <br /> 5. i/ .,✓. — //S� ! <br /> - <br /> 6. �� �-..... .,�Unit 4 <br /> l Gf <br /> 7. <br /> 8. ❑Unit 6 <br /> 9. <br /> 10. ❑Unit 6 <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 FACILiTY/VEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) F-1FOODFACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ?r9AZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING _F�: 'OOMPLAINVRESPONSE 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. 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 mall 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 ten (10) <br /> clays 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 to 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 Flle reviews by the sarne applicant may require a$125 deposit prior to review. <br /> --.-, �, i fir. -,;`•.'— <br /> Q Records prpVidea by Staff-RPR Gomo.iwtp, 441fflan,tes <br /> . ema�z <br /> EHD f8•DO <br /> Received Tiriie Jan. 14. 2015 11 ,49AM No, 7909 <br />