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1 From: OR/M 15 15:50 #052 P.001/001 <br /> I O <br /> DATE RECEIVED EHD LOG NUMBER <br /> _ RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 4f <br /> FEB 17 20 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> lephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �y1{�D 1 �—� t, q �. BUSINESS/AGENCY: J[n r <br /> ADDRESS: ��' >�jp 'li i'�� .S�, S�F sC?/ CITY/STATE/ZIP: C4 9 <br /> PHONE(1): Aja-.S�.3D.S—�.IC) PHONE(2): FACSIMILE: �o'L.S-3wsa�/3 <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 RE EST-$130 FEE -QR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS A <br /> SIGNATURE OF APPLICANT 1 DATE_ ahl� .� <br /> Electronic Information: ❑ List❑ hap-- scription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City{{ ❑Unit1 <br /> 1. 7 705 <br /> 2. � 0 Unit 2 <br /> 3. <br /> 4. <br /> nit3 <br /> 5. 1- <br /> 6. nit 4 <br /> 7. <br /> 8. <br /> ❑Unit 6 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From 9 4/O to Pe E!Jq <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑F000 FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:OOPM(EXCLUDING 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 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 providedl by.Staff_-PPR Complete. Staff Name: <br /> EHD 4806 <br /> Received Tile Feb. 16. 2015 3: 50PM No. 8138 ) <br />