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05/06/2015 1 : 19 : 07 PM -040" FAXCOM ANYWHERE PAGE 2 OF 2 <br /> DATE RECE�E SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> r 6/1l <br /> r 9ENVIRONMENTAL E LT DEPARTMENT <br /> HEALTH H <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> (,n PUBLIC RECORDS RELEASE APPLICATION' �R <br /> APPLICANT: _y0z BUSINESS/AGENCY; <br /> ADDRESS: 31 CITY/STATE/ZIP: _EQ �, G L} <br /> PHONE(1): !16 j �S.3 77`] PHONE(2): �_ FACSIMILE: <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-$�E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT T?/n DATE <br /> , <br /> Electronic Information: ❑ List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name Cit ❑Unit 1 <br /> z. <br /> p �1 lit <br /> �j O V (� �,. a Utti ❑Unit 2 <br /> 4 I nit 3 <br /> 6. <br /> Unit 4 <br /> —- -......_. _....................... <br /> — --- -- <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. I � ,► /5 <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> JTIEUNDERGROUND <br /> TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY OLID WASTE FACILITYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) ElHOUSING ABATEMENT WASTE TIRE <br /> DERGROUND TANK(MONITORINGIREMOVAL) [jFOOD FACILITY E]DAIRY <br /> OVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL E]PUMPER TRUCKIYARD/CHEMICALTOILETS <br /> RED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑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 up ten addresses 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 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$130 deposit prior to review. 'BOXED AREA-EHD USE ONLY**` <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 08101114 <br /> Received Time May. 6. 2015 10: 19AM No- 8638 <br />