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DATIS*, 22. 2015 2 : 13PM No. 1911 W. 4 <br /> T ' SANJt3AC�UIN COUNTY G NUMEER <br /> ? � ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 14 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . Telephone: (209) 468-3420 Fax: (209) 464-0138 Weis: www.sigov.org/ehd <br /> ENNMON%4-Mt�TAi.i-1EALTE1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: on (,S BUSINESS/AGENCY: SJ CO(�1� PLL61 Wy�'�! <br /> ADDRESS: 6ton CITY/STATE/ZIP: gruu'1/"rft Lq 7-sw"� <br /> PHONE (1): PHONE J 1 �(G�'���� PHONE (2): FACSIMILE: <br /> Blease allow 10 business days from date of application submittal for the records t0 ire avallahle. <br /> rr <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE I's- <br /> Electronic Iinformation: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Str®et# Street Name City <br /> EHD USE ONLY <br /> Ijl Vui w � D( I�� ��c lC"f�✓ t,a µ► ,P-�� <br /> 2. i 'Unit 1 <br /> 3. [ Unit 2 <br /> r7. <br /> [2'/Unit 2H <br /> D'Unit 3 <br /> [Uit 4 <br /> ` SITE MITIGATION <br /> 9. <br /> J. <br /> allnit 5 <br /> Spaclt3a Date Range of Information Roquested- From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 'E]-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACIUTYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ®HOUSING ABATEMENT WASTE TIRE <br /> �JUNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ,�DAIRY <br /> ,,ABOVEGROUND TANK 'CHICKEN RANCH/DOG KENNEL [WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUs MATERIALS ❑MOTELIHOTEL OPUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ®POOUSPA _LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING OCOMPLAINTIRESPoNSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MoNDAY-FRIDAY S:OO 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-Q138 or mail to the address Indicated above. Address <br /> ranges will not be.accepted.Applications received after 3:00 pm will be processed the nekt 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 /> sho::!d bo sched '!a-d accord;^.gly. <br /> 4. Any fife not returned In the same condition as released will ba 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 /> cc,fc nnn nQ-Y_�_� Staff Name-- <br /> Received Time=Sep, 22. _2015= 2 : 09PM_No, 9621 <br /> EHD 0-4G 7/1/15 <br />