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`DATIS6 , 22. 2015 2: 13PM No. 1911P. <br /> EE 30 NUMBER <br /> _ _ SAN JOAQUIN COUNTY <br /> m, EC <br /> D ENVIRONMENTAL Hr=ALTH DEPARTMENT <br /> 868 East Hazelton Avenue Stockton, CA 95205-6232 . <br /> OCT 14 ZfTA <br /> Iephone: 209 468-3420 Fax, (209) 464-0138 Web: v�wvd.s ov.of /ehd <br /> I�RE(OtI1� F�lfl<<la6a���;l 14FAITH PUBLIC RECORDS RELEASE APPLICATION <br /> PE("'NIIPSE�MUM APPLICANT: <br /> ADDRESS: i� G �. � P �2, CITY/STATER€P: 00 rp,� , <br /> PHONE ('i): PHONE (2): FACSIMILE: <br /> Please -allow 10.husiness days, from date of C•fcpli^anon sUbiiittai&o6 t1E6 4GVvrdS to be 0.vQ[IQI"riG. <br /> Staff will contact you to arrange an appointment data and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE:za:= <br /> HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ElectronicInformation: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Narne City EHD USE ONLY <br /> W walfil L C_(11� SjLU�"fiU'� l�t^�,b,�-��, Ll avc i s Capp <br /> 2• WI 6VII am 00 Vl; S�LUL`91�Y1 t�(-d= Unit 1 <br /> ' 3. 3 ^L L,(v cz <br /> 4. 3Z2(o V 0(/ Vllfl 2"Unft2H icv <br /> 6. lf�2 aw cP_ Qn/,li& Unit 3 <br /> 7. �1p N. T �(( f (/i✓ SE1X.11% p u it <br /> 9. Zip°I tr• "�t7YYl15z hA vim- Pr-1 ve, <br /> }]'Unit 5 <br /> Specific Data Range of Information R. quested: From. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE <br /> Q'UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY DAIRY <br /> ABOVEGROUND TANK ®CHICKEN RANCH/DOG KENNEL g]WASTEWATER TREATMENT PLANT <br /> HA2ARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL EE?PUMPEP_TRUCK/YARDICHEMICA.LTOILETS <br /> TIERED PERMITTED FACILITY POOLISPA �D LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AvAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> I. 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 /> shy uid be schedu;ed accordingiy.. <br /> 4. Any fife 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$130 deposit prior to review. '''BOXED AREA-EHD USE ONLY— <br /> A91;ael F05 VA U O G �- �Gsa� tom' �� 3*2 ','� LvAa &,d. D.-7 -T-epee- Pu4tX Clr--, <br /> tam w.-, mL 2 73Tem �.C� I���� Ccs ��567 c Ak(0 , -A �, ,oe41,e <br /> M 0--A— ..rr..,r �,, a 131, 14l)fl ►arlo r,C"'_I_`_ Staff Name: <br /> Received Time=Sep. 22. =2015= 2: 09PM--No. 9621 <br /> EKD 48-06 7/1/15 <br />