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DA De c`21:`2015 10:46AM No. 2 19 5 Enu LUG NUMBER <br /> SAN JOAQUIN COUNTY <br /> °f ENVIRONMENTAL HEALTH DEPARTMENT pppPPP <br /> i� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> • PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Uc &l n s BUSINESS/AGENCY:y57COI P-7 PW,j f bG (�.5 <br /> ADDRESS: (gyp A/.re"If� fy-r-,- CITY/STATE/ZIP: St ')57-0,5- <br /> PHONE(1): C'uq) gfjSl_ 30K PHONE (2): FAX OR E-MAIL: Qpfl C. ut— 2j rf <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 EJ(pEDfTE <br /> REQUEST <br /> `�-LIZjO� EE. SH OR CHECK ONLY)-REQUEST PROCESSED IN 3,BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /� yLCf.0_� ir_ DATE ..14/1 _._. <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street q Street Name City <br /> 1. '"5q P. s irw nV4 ._rKvq <br /> 2. �(i1��J� S n �Drj3. I T� ✓nitt <br /> a` �'r e'I�c YI,U�G(�✓1i 6�/fi launh2 <br /> 4. �}°f0( S (rif'('�'ry1VwG43QL/Init2H 2�E <br /> 5. qgo '. l��w�t1,',,17"/l/L(i��. /�,.e .. � GL� �lfJnit 3 I� <br /> 6. ^a-�7,n��7v^ S trtivl lyf mLn � K(/�'l 7�{ICY 19/6nitit 3HM <br /> 7• d'��"JJ � (.G(/1�INI.�/� lu'l �Vv� L'�J Unit4 <br /> B- �71+s W [466 (^,ull Or _WC U"8ITE MITIGATION <br /> 9. 3 S [uaau- �r 'lam 6dUnitS <br /> 10. 1145 S MGfha1�! .�'' 7�a <br /> Specific Date Range of Information RCquested: .From to <br /> ,,,���/// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL SOLID WASTE FACILITYNEHICLE <br /> UTHER CLEANUP SITE(NON-LOP) [1iOUSING ABATEMENT ❑FOOD FACILITY <br /> NDERGROUND TANK(MONITORING/REMOVAL) �Ey'WASTE TIRE DAIRY,POOL)SPA <br /> ABOVEGROUNDTANK u CHICKEN RANCH/DOG KENNEL ASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE - ❑MEDICAL WASTE FACILITY LIMPER TRUCK/YARD/CHEMICAL TOILETS <br /> RDOUS MATERIALS ❑TATTOO/BODY PIERCING �ND USE APPLICATION SITES <br /> IERED PERMITTED FACILITY I�OMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM5:00PM(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 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$130 deposit prior to review. <br /> —BOXED AREA-EHD USE ONLY" <br /> Received Tim}—uvercun2u1. —y201d-10:42AN-No. 0231 <br /> uwoflrrrrc <br /> 1,ompiete. Staff Name: <br />