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Q 'Fah. 25 2013 09:22AM P1Ohl JODI UANNEMAN FAX NO. 4154793988 <br /> ci1 ,'1 EHD L,QG NUMBER <br /> DATE L LCy { „s.T s�'� 'y ` _` SAN JOAQ.UIN COUNTY <br /> B �}� <br /> ENVIRONMENTAL HEALTH DEPARTMENT 5232 <br /> 3888 East Hazelton Avenue, Stockton, <br /> TelephonIe: (209) 468-3420 Fax: (209) 464-0338 Web:www.sjgov.org/ehd h' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> � ( <br /> APPLICANT•_ a 1'] n���1a, BUStNESSIAGb<i1lCY: <br /> ADDRESS: LIC CiTYfSTATFIZIP: <br /> PHONE(3): � PHONE(2):L/ —L , _ FACSIMTLE: �I <br /> TE FA ITA/E*APPO I NTMEWr DATE:_ Time: <br /> (Please allow ttt business days from date Qf application submittal-']"erltatfve only-must be confirmed)w <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR'CHECK ONLY)-REQUEST PROCESS FED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List[ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City El Unit i <br /> 2. ` ^ ( ull Unit 2 <br /> 3. <br /> units <br /> 1--le, 4 i <br /> 7. <br /> 10. D Un it 6 <br /> f <br /> Specific Date Range of Information Requested: From to <br /> ENVIROMMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANI((UST)CLEANUP SITE(LOP), Q HOUSINGABATEMFNT ❑SOLID WASTE P1AGILITY1V6HICLE <br /> _ S3NER CLEANUP SITE(NON-LOTS) ❑FOOD FACILITY El-WASTE TIRE <br /> _,P_;NNDER6ROuNv TANK(MONITORING/REMOVAL) �Q DOG KENNEL ❑DAIRY <br /> �AZARDUUS WASTE GENERATOR ❑CHICVS—N RAUCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOT WHOTEL El PtfI+APE.R TRUCKIYARDICHEMICAL TOUTS <br /> TATTOOIBQDY PIERCING Q POOL ISPA LAND USE APPLICATION SITES <br /> CI MEDICAL WASTE FACILITY COIIEPLAINT RIwCORDS Q OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RF=coRns ARE AVAILABLE FOR REviEvv: MONDAY-FRLDAY$:OOAM-S:DOPM(ExcLuDiNG HOLIDAYS) <br /> i <br /> 1. List up to ten addresses in the space above. Selectthe 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(g 464-13138 or Mail to the address indicated above. Address <br /> ranges will not he accepted -for additional assistance with file addresses,contact the EHI).:Applications received after <br /> 3:00 pm will be processed the next businessday. <br /> 2: The EHD will notify the applicant if any EHD files exist An appolntment for.review will be confirmed approximately ten (10) <br /> days atter receipt ofappllcatlon. The Wes will beheld Ibr a rrraximurn of five business days for revicw. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any bile not returned in the same conditlon 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$925 deposit prior to review. <br /> L <br />+� ENA"-OG srv�a <br /> Received Time Feb. 25. 2013 8: 20AM No. 2388 <br />