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NOV-19-2014 WED 02:21 PN KLE I 1"-GLDER FAX N0. 80 i IR 13306 P. 02 <br /> j\jED EHD LOG NUMBER <br /> pATERECI IV DL ZQ1� SAN JOAQUIN COUNTY <br /> Ivv U ENVIRONMENTAL HEALTH DEPARTMENT <br /> �`tia 11 ,=i\l'hk'. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 1�1=�'��IlilSs�+'4�'T�T•ephone: (209) 4683420 Fax: (209)464-0138 Web: vvww.slgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; < BUSINESS/AGENCY: �1rFGr 662 <br /> ADDRESS: _ o i p2. eZ'2 _ CITYISTATEIZIP: c.r G.a� c <br /> v r <br /> PHONE (1): - � PHONE (2): a _7i 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-$130 FEE(CASH OR CFIECK ONLY)-REQUEST PROCESSED IN 3 DuSINESS[DAYS <br /> SIGNATURE OF APPLICANT ADATE <br /> Electronic Information: ❑ List ] Map—Description: ST <br /> EHD USE ONLY <br /> FILE ADDRESS <br /> Street# Street Name Clty Unit 1_ <br /> �tk6> <br /> 2, ep ,tJ -TR acs �Ct 7-C AC. Unit 2 <br /> cI <br /> 3. z7G :V_8 , Q LAI--:4 ' �,,.1 <br /> r I_\ /[]Unit a <br /> 4. <br /> 5. CaQ�2AL, dJc% T � r <br /> unit4 <br /> 1 <br /> 7. L.A 2 G1-! Q "rQ.AC <br /> 8. Q-1 AG ❑Unit 5 <br /> 9. <br /> Unit 6 <br /> 110. <br /> Specific Date Range of Information Roquested: From /y�l D <br /> to r R <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYNFHICLE <br /> *UNOERGROUNP TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY WASTE TIRE <br /> *OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑DAIRY <br /> ®UNDERGROUND TANK(MON ITORINGIREMOVAL) L1 FOOD FACILITY ❑WASTEWATER TREATMENT PLANT <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL <br /> PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑❑POOLISPATEL LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY <br /> ❑TATTOOIRODY PIERCING ®COMPI.AINTIRESPONSE RECoRIus ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REvIEw. MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> �. 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 he selected. Fax to 209 46 - 39 or ma 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 /> Z. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3 ynotify e If <br /> Dwill <br /> be confirmed approximately (10) <br /> days afterreelpt f application. The files will bei held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly <br /> s released will be reorganized by EHD staff at the expense of the applicant. <br /> 4. Any file not returned In the same condition a <br /> Future file reviews by the same applicant may roquire a$130 deposit prior to review. ^'eOXE AREA- WD USE ONLY"` <br /> Q Records provided by Staff-PPR Complete. StfrNime: oelotia4 <br /> EKp 48-05 <br /> Received Time Nov, 19, 2014 1 ; 34PN No. 7594 <br />