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NOV- 19-2014 TOED 0221 PN UFF 7LDER FAX NO, 80iQR13300 P , 02 <br /> EHD LOG NUM6ER <br /> PATE RECEIV D ' <br /> N0 ( 201G4 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DE=PARTMENT <br /> -A 1868 East Hazelton Avenue, Stockton, CA 95205 6232 <br /> y ,f 1111 3ef phone: (209) 468-3420 Fax: (200) 464-0138 Web: www.slgov.org/Ghd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> WERE <br /> APPLICANT :- n P t BUSINESS/AGENCY: ee IGiSe heS <br /> ADDRESS: a o _ CITYISTATEIZIP:�Ac'r 44 <6 <br /> PHONE (1 ): PHONE (2): c C2 / est 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 /> 0 CHECK GOX TO EXPFDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 PUSINESS PAYS <br /> SIGNATURE OF APPLICANT A DATE ftl <br /> Electronla Information' ❑ Llst [ Map Description' Sire Ao mdwp,irxe <br /> FILE, ADDRESS EHD usu ONLY <br /> Street f4 Stcaut Namo city Unit 1_ <br /> 4L./ 4A entIp <br /> 2, yo ✓ raae,�� . o •rk4 t\��Ilrly unh2 <br /> TL� ]I Ga '✓.J. i . <br /> 3. Z 7Ge — <br /> IJnit "1 <br /> 4, o cpa & A a.ARe� <br /> 4.aUnit I <br /> ria <br /> 7. 4A% C9 Q T AG <br /> e. 50� Ga2c 7� CSO QAG 1 ❑ unit s <br /> 9. <br /> F UnIt6 <br /> Ion <br /> Sp®cltle Dare Ronna a4lnfarmatlon RoNtaesteQ; <br /> From '4 ( 4 <br /> ENVIRONMENTAL HEALTH ®EPARTMENT FILES SOLID WASTE FACILITYNFHICLE <br /> UNDERGROUND TANK (UST) Ct FANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY <br /> PW OTHER CLEANUP SITE (NON-LOP) ❑ HOUSING AfIATEMENT El WASTE TIRE <br /> MY� UIIDEROROUND TANK (MONITORINeIRvmovAL) l] Foop FACILITY rE�lDAIRY <br /> E] TREATMENT PLANT1!q ARDVEGROUNP TANK ❑ CHICKEN RANCH/ Don KENNEL h <br /> PU MPFR TRUCKIYARDICHEM ICAL TOILETS <br /> ® HA%ARDOUS WASTEIHAZARDOUS MATFRIALS L MOTELINOTEL ®® LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY ❑ POOLISPA <br /> ❑ TATTOOIRODY PIERCING IN COMPLAINTIRESPONSE RECORps 0 OTHER (PLEASE SPECIFY) ' <br /> WELLAND SEPTIC PERMIT RECORDS FIRE A_VAILA131-E FOR REVIEW MONDAYorRIDAY 0 : 00 AM-S:OOPM (EXCLUDING HOLIDAYS) <br /> 1 . List uD fa ten addresses in the spaeu above. Select the .type(s) of (Iles from the list above by checking the appropriate <br /> box(es). At least Una file type MUST he selected. Fax to 2091 Aa4 0 Se or mail to Chea ess in catAd above. Address <br /> ranges will not be accepted. Applications received after3:00 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 /> be confln-nod <br /> 3z <br /> days after recel notify <br /> t of athe <br /> applicant <br /> /f any The fuelO files exist. An appoilitmont for review s will be held for a maximum of five business days far rev aw. pAppointments ately tan (10) <br /> Y p PP <br /> should be scheduled accordingly. <br /> 4. Any file not returned In the same condition as released will he reorganized by EHD staff at the expense of tile applicant. <br /> Future file reviews by the same applicant may require a $130 deposit prior to review. ^'t3oXEP AREA - FWn USE ONLY"'" <br /> ROOM <br /> [�ffRecords provided by Staff=PPR Completa. starTNan,®: oeiolrla' <br /> Flip 40 06 �A�•��— <br /> Received Time Nov , 19 , 2014 1 : 34PN No . 7594 <br />