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l�. Uec. 10. rlvl IVO. Qyyq r. i <br /> I <br /> IL DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTNiEN-f ,�- <br /> RECT DEC ' S (�j 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ' <br /> �*1hone: (209)468-3420 Pax: (209) 4.64-0138 Web: vAm.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 4MIJ BUSINESSJAGENCY:\32� -Lo.6a,,,C"*4 64, <br /> ADDRESS: r�( �, 1��G�1�L�d r7 ��I/,% CITY/STATEIZI P: (t S?- <br /> PHONE (1): L4 -"9`T PHONE(2): _ _ FACSIMILE:_ 4-G,,4 <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 RE -5130 (CA H O HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: 1st❑ --Descript n: <br /> FILE ADDRESS END USE ONLY + <br /> Streot# Street Name City Unit 1 <br /> 1- 3 2.S2-f S- 60 P-M` WO Ito w/W r. <br /> 2• 2 7 •� . GLCow r:- TKA-c. M Unit z <br /> `t 45£5'D S. C.oaaAt f2-•0 i .,Unit 3 <br /> 5• <br /> 1-fFif'Mer—< ao /�'! j�p "1 �� El Unit 4 <br /> 7. ,., <br /> D - vC UL7`ic aD <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10. IS 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 FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ,`�HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) FOOD FACILITY DAIRY <br /> ABovEGROUND TANK ',CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HA7-.RDOus WAsTeIHAZAADOUB MATERIALS ❑MOTEUHOTEL PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ®POOUSPA LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING COMPLAINT/RESPONSE RECORDS POTHEP,(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 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 FHD flies 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 rev!Vws by the same applicant may require a$130 deposit prior to review_ ""BpXED ARF-A -EHa USE ONLY " <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD AB-06 G8/WI. <br /> Received Time Dec. 18. 2014 3 : 36PM No. 1748 <br />