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mW6/06/2013 14:32 FAX 925 946 90 ERI4 41EST WC • <br /> ■ <br /> PD L('G''A-, <br /> UM13ER <br /> 9 V SAN JOAQUIN COUNTY <br /> ■ )ll(t! 6 20t), ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone; (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> D <br /> APPLICANT: e-Gb-, eW� u BUSINESS/AGENCY: rll\- <br /> ADDRESS: 12-- _-) -) 7 r 8 1 j -e 0 CITY/STATE/ZIP: <br /> PHONE (1)- 04,5' - L('g I - 3 PHONE (2): FACSIMILE: <br /> TENTATIVE-APPOINTMENT DATE' Time: <br /> (Please allow 10 busInear,days from date of Application submittal-,Tentative only-must be confirmed) <br /> Ej CHECK SC)X TO EXPEDITE REQUEST-$42-5 FY=E(CASH OF!CHE�K ONLY)—REQUEST PROCESSED IN 3 BUSINESS DAYSSIGNATURE OF APPLICANT X 14�� 6j / DATE <br /> lElectronic Information: L] List Ll Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name city 0 unit I <br /> AvIL <br /> 2. 'AQ Unit 2 <br /> 3. <br /> 4. ,C]unit3, <br /> 5. 1 V �-V­ & 1 F:3' <br /> 6. tl/,It J4 <br /> 7. <br /> Unit S <br /> S. <br /> 110. 1 1 El unit 6 1 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) [3 MEDICAL WASTE FACILITY, SOLID WASTE FACILITYNEHICLE <br /> [B OTHER CLEANUP SITE(NON-LOP) - [:]HOUSING ABATEMENT ❑WASTE TIRE <br /> CI UNDERGROUND TANK(MONn-ORINWREMOVAI.) ❑FOOD FACILITY Ej DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/Doo KENNEL 0 WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL C]PUMPER TRUCKIYARDICHEMICALToILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA []LAND USE APPLICATION SITES <br /> TAiToCIBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS [:)OTHER(PLEASE SPECIFY) <br /> WELL AND SEP-TIC PERMIT RECORDS ARE AVAILABLE FOR REviEw: MONDAY-FRIDAY 8:00 Am-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ton 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 jQ_(209)4_64;Q138_Qrmall Wthe,address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addrdsiaes,contact the EHD. Applications received after <br /> 3-00 pm will be processed the next business day. <br /> ?. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(1 D) <br /> days after receipt of application. The files will be held for a maximum of five bualnoaa days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately 2V2112b[o for review. A now application may be <br /> submitted when the file is available, <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of thea 1.i.cant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> .......... <br /> t X 11A, T WON,I"MWh, <br /> EHO 49-06 <br /> Received Time J u n 6. 2013 3 05PM No. 3294 <br />