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6/10/2014 06:09 FAX0 <br /> oto 0001/001 <br /> MM SLE C EHDLGNUMBER <br /> E SAN JOAQUIN COUNTY <br /> �q <br /> 2014 ENVIRONMENTAL HEALTH DEPARTMENT .. '"✓ <br /> JUN 7 0 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Tele hone; (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> EN,TCcAaal c�'Lsr� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �r �,., n RFd BUSINESS/AGENCY: A� �a.tJSUcrAAIj$ <br /> ADDRESS; / CITY/STATEIZIP: 4y&j,6y� GAg f4 -9 <br /> PHONE(1): S-36'42,9-9428 PHONE (2); ';�- FACSIMILE: <br /> Please allow 10 business days from date of application submittal forthe records to be available. <br /> Staff will contact you to arrange an a ointment d to and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQU -312 E-tZASH O H K ONLY)-REQUEST PROCESSED IN 3 eU INESS AYS <br /> SIGNATURE OF APPLICANT DATE /b <br /> Electronic Information: ❑ List❑Map escrlption: <br /> FILE ADDRESS EHD USE ONLY <br /> 3treetR Street Name on \�El Unit <br /> kccf 0,�1 � <br /> 2. A AtI00A C[ i ��( Unh2 <br /> 119 <br /> 4. Se C.. ._ Al Un It <br /> / o o <br /> 5. 1Q I�� X;V1 'Unitr <br /> 7. f <br /> f 1 ❑ units <br /> 9. �kl'z f((�VC _ ;x(71- <br /> 10. ; , ` . .� ur � ,ZL4R'✓LC1� <br /> , vI`'�I`I a unit a <br /> Speome Data Range of information Requested: From - to �0 <br /> ENVIRONMENTAL EALT DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILRY E]SOLID WASTE FACILINNEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ERGROUND TANK(MONITORINWREMOVAL) ❑FOOD FACILITY D OWY <br /> ^�VEGROUNO TANK Q CHICKEN RAHCHI Doe KtNNEL n4ASTEWATFR TREATMENT PLANT <br /> AZARDoUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL E]PUMPER TRUCKIYARDICHEMICALTOILEr$ <br /> j ¢RED PERMITTED FACILITY ❑PpcesPA �L D USE APPLICATION SITES <br /> ❑TATrooBDDY PIERCING �4fOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0OPM(EXCLUDINe HOLIDAYS) <br /> 1. List uo M ten addresses In the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(es). At Is, one file type MUST be selected. Fax t (209)464-0138 or mall 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 flies exist. An appointment for review will be confirmed approximately tan(10) <br /> days after recelpt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any flee not returned In the same condition as released wtU be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$126 deposit prior to review. —PQXEP Ate-EHD USE ONLY-" <br /> f] Records provided by Staff-PPR Complete. Staff Nam@: <br /> �eoe <br /> uzeru <br /> Received Time Jun, 10. 2014 6:07AM No. 6295 <br />