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F e b. 2, 2016 1 :49PM No, 2355 P. 2 <br /> DATE tMV�D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> RE <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -1868-East-Hazelton Avenue-,-Stockton,-GA 95205-6232- <br /> Telephone: (2 09)468-3420 Fax; (209) 464-0138 Web: www.sjgov.o <br /> rL.=W RONNA E14TAL HEAL� <br /> T p <br /> Sr.wCE5 PUBLIC RECORDS RELEASE APPLICATION i <br /> APPLICANT: Lffi_� BUSINESSIAGENCY: " Tcoarq e1twr-, U/06,GS <br /> ADDRESS: E. 2 6- CITY/STATE/ZIP: Gln G15 2,05 <br /> PHONE (1): PHONE (2): FAX OR E-MAIL: <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 /> 0-6-HC–E--II60X <br /> _TO*­T-0EX''' '*EXPEDITEREQUEST- <br /> ______ _ --$-_1'3_*0EE(CA <br /> _F__--SH0 <br /> --------- <br /> "__-RH <br /> * CHECK-E*_CK-__'0''ONLY) EQ <br /> '_-_R__U—ES-T0—P R__'C-E'S_'S'_E'D_1,N3BUSINESS <br /> _­____*' DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: Lj List 0 Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name city <br /> 30000 S " un 1 Unit 1 <br /> 2. 3 r) I UL)L X <br /> E3'Unit2 <br /> 3. -3 0 -a ww <br /> 4. 0tTl►- poy'�-- F,Unit,7H <br /> 5. VV 1��i n ct� Tra C/� Unit 3 <br /> .7 1,0� <br /> 6. rA oA <br /> D/Unit 3jiM <br /> A <br /> 7- <br /> W E]'Unit 4 <br /> - <br /> �i 610 S azi!u (5(lid 7(01 W, 0SITE MITIGATION <br /> Is 17M L/k/ N114 -7rm a/ <br /> 10. 4/ ) EI Unit 5 <br /> i--M'2_ S Iva(y ti M 70W 1 <br /> Spa,clflc Date Range of Information Requested. From to <br /> -ERV1k5RMl=-NT­A_L HEALTH DEPARTMENT FILES <br /> [0-UNDERGROUND TANK(UST)CLEANUP SITE DSOLID WASTE FACILITY[VEHICLE <br /> D'OTHER CLEANUP SITE(NON-LOP) g-HOUSING ABATEMENT Lj Fool)FACILITY <br /> D'UNDERGRouNE)TANK(MONITORINGIREMOVAL) ['WASTE TIRE MDAIRY,POOLISPA <br /> ErABovEGROUND TANK [CHICKEN RANCH/DOG KENNEL DWASTIEWATER TREATMENT PLANT <br /> ZHAZARDOUS WASTE F1 MEDICAL WASTE FACILITY [)'PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> EPWARDOUS MATERIALS []TATTOO/BODY PIERCING ❑UND USE APPLICATION SITES <br /> 0-TIERED PERMITTED FACILITY Ea'COMPLAINTIRESPONSE RECORDS Ej OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00Am-6:00Pm(ExCLUDINr,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 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 retumad 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$130 deposit prior to review. <br /> —BOXED AREA-EHD USE ONLY' <br /> 0 Records provided by Staff-PPR Complete. Staff Name-, <br /> Received Time=Feb, 2. =2016= 1 :44PM=No- 0434 <br />