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08/20/2014 14:47 FAX G002/002 <br /> DATE RECEIVED w, EHD LOG NUMBER <br /> ta <br /> \� y SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> AUG 2 OTaQhone; (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> FF " HEAPUBLIIC RECORDS RELEASE APPLICATION"2 1� <br /> APPLICAAWMt qr'o I-lo BUSINESS/AGENCY: eJ ccv%SL. ( 1-, L <br /> ADDRESS: L�5"2)� � �qv v.o[IC �� SiC, 50o CITYISTATEZIP: 1r Q I a' <br /> PHONE (1): �rX O. 833 �3y �j_ PHONE(2): �r� t� •�4-O Fr 0p 3 FACSIMI <br /> Please allow 10 business days from dale of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment data and time to review the requested records, <br /> HECK BOX TO EXPEDITER EST-5125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS" <br /> SIGNATURE OF APPLICANT( up DATE 9, �p�►y- l % �:��; <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 34eet# Street Name City ❑unit 1 <br /> .v%PQ tuo <br /> �� 3�7p 1\) I-•1... ASH'^^ Sjtl Unit 2 <br /> i �� Unit3 <br /> J.ri/' ❑�nn4 <br /> 7. <br /> B•` ❑Unit 5 <br /> 9. <br /> 10. unit B <br /> Specific Date Range of Information Requested: From C9006 to ,pr�p6c"-^t^ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 7'� <br /> RVNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FAC[UTYNEHICLE <br /> 2"]'THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> 2'ONDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> L❑'ABOVEGROUND TANK ❑CHICKEN RANCH(DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> it❑1WARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK)YARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTODIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS p OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:001?M(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresser In the space above. select the type(s)of fills from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-013B 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 END at the number noted above. <br /> 3. The EHD will notify the applicant If tiny 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 some applicant may require a$125 deposit prior to review. —BOXED AREA-EHD USE ONLY— <br /> [I Records provided by Staff-PPR Complete. stuff Name: <br /> EHe"40 4RW14 <br /> Received Time Aug. 20, 2014 1 : 51PM No. 6874 <br />