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NOV-19-2014 WED 02:21 PH KLEI LDER FAX N0. 80613308 P. 02 <br /> 9y i S <br /> EHD LOG NUMBER <br /> DATE RENOv D` 9 2014 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 Jlh0-" kk lc )Tt;l_;^rr°='r' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 �Ne <br /> PE4 NAVTOE;'tN'FoTephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: n t?,aoe, BUSINESSIAGENCY:�LFj �Er eE2 <br /> ADDRESS: v o• o CITYISTATEIZIP: c4ar Gaels c f T <br /> PHONE (1): PHONE (2): -7/ z$6e� FACSIMILE: <br /> Please allow 10 businOSS 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 PDX TO EXPEDITE REQUEST•$130 FEE(CASH OR CFIECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A Fr�e DATE /1/ /7I7?o/LJ� <br /> Electronic Information: ❑ List[j Map—Description: r <br /> FILE ADDRESS EHO USE ONLY <br /> Street Street Namo Clty Unit 1_ <br /> 2, yo ✓ �R ac O YQnG \ILLS unit2 I <br /> 3. Teac, <br /> 4. <br /> MIA Unit 3 <br /> 6• "TQ.1.G.d A ✓ '✓ 7Q G� /l �`� �1 � Unita <br /> 7. C,AR.G7-t Q.� TQ.AG <br /> B- $O'S d,g2G70 Cr-.D 2AG ❑Unit s <br /> 9. <br /> 10 units <br /> Specific Date Range of Information Requested: From <br /> p to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ®SOLID WASTE FACILITYIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE Tin <br /> ®UNDERGROUND TANK(MONITORINOIREMOVAL) [2 FOOD FACILITY ❑DAIRY <br /> RANCHI DOG KENNEL ®WASTEWATER TREATMENT PLANT <br /> ®ABOVEGROUND TANK ❑CHICKEN PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑ <br /> ®TIERED PERMITTED FACILITY E]POOLISPA ®LAND USE APPLICATION SITES <br /> ❑TATTOOIRDDY PIERCING ®COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY^FRIDAY B:00 AM-5:001'M(EXCLUDING HOLIDAYS) <br /> 1. List UR to ten addresses in the space above. Select the type(s)of flies from the list above by checkingthe appropriate <br /> box(es). At toast Dna file type MUST b®selected. Fax to 2091464 Q138 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 FHD 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 he scheduled accordingly. <br /> 4. Any file not returned In the same condition as released will be reorganized by FHD staff at the expense ofthe <br /> theD applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. —BOXED AREA. <br /> EUSE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete..sranNam®: neiovta <br /> rK13 4MG <br /> Received Ilene Nov. 19. 2014 1 : 34PM No. 1594 <br />