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AUG- 14-2014 THU 09 : 23 AM Moor" kTwining Associates FAX NO. 5r ` ?68 7126 P. 02 <br /> d <br /> `� ��� �- •� EHD LOG NUMBER <br /> 'DATE <br /> 'Vin SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT s *3qO 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telep"IA209) 468-3420 Fax: (209) 464-0138 Web: wwiw.sjgov. org/ehd <br /> "Ia(afs 1I0'UBLIC RECORDS RELEASE APPLICATION <br /> 'APPLICANT: /Il NII-CL „ � K� BUSINESSIAGENCY: C'Zcyre <br /> ADDRESS : 25 2 1117 Fre Seo S F.ee r CITYISTATEIZIP : res., o, CA Y3 7e, <br /> PHONE (1 ): (SSY) Z6 — 70-Zr PHONE (2) : (5-1 278 - 9SgI FACSIMILE: &s-&i ) 26le — '7126 <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 REQUEST - §t25 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r�.� � — V DATE 81131,,1`K <br /> Electronic Information : ❑ List ❑ Map _ Description : <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name City ❑ Unit 1 <br /> 1 , I S5 W. FrEw, O r�.¢- }ref.+- t S'(oc[c-tu ^ I(..✓.�1,.L <br /> 2. �a;LS LJ. Fre N�.cN n-1- S4- ree � S4ecL. ka r1 �LR7 Unit <br /> 3t ,l2q <br /> Sit <br /> f jt <br /> 4 �'�� .�' L.7 . Fren..a 4- ee+ -,�ncLcd-a �I t ., _D Unft3 <br /> / ;la ., SFre <,�--;1 �. _ ,S �o < r� 1aI O lul � � :ETUnit4 <br /> w <br /> 9 <br /> 10 . (]'Unit G <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONME,N�T`p:L HEALTH DEPARTMENT FILES �J <br /> (� U QERGROUND TANK (UST) CLEANUP SITE (LOP) L� MEDICAL WASTE FACILITY tyf SOLID WASTE FAciuTYNEHICLE <br /> rryy THER CLEANUP SITE (NON-LOP) ❑ HOUSING ABATEMENT [] WASTE TIRE <br /> tlCl bNDERGROUNO TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑pAIRY <br /> ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT <br /> ��,rH� AZARDOUSWASTEINAZARDOUS MATERIALS ❑ MOTELIHOTEL <br /> Ly ❑,/PUMPERTRUCKIYARDICHEMICAL TOILETS <br /> I IERED PERMITTED FACILITY r❑ POOLISPA I� LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ICI COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM<5:00PM (EXCLUDING HOLIDAYS) <br /> 1 . List u0 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 (208) 464.0.138 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 anti content of EHO 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 /> i 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 $125 deposit prior to review. N'"BOXED AREA • EHD USE ONLY"` <br /> i <br />'I <br /> i <br /> j ❑ Records provided by Staff-PPR Complete, staff Namet <br /> 4 <br /> .4128114 <br /> cu a: <br /> Received Time Aug . 14 • 2014 9 : 14AM No . 6831 <br />