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E12/13/2013 15:19 FAX 916372256' -� WALLACE-KUHL AND ASSOC. � IM001
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<br /> DATE RECEIV EHD LOG NUMBER
<br /> �■ SAN JOAQUIN COUNTY `
<br /> ENVIRONMENTAL HEALTH DEPARTMENT /t
<br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br /> Thone: (209)468-3420 Fax: (209)464-0138 Web: vwvw.sjgov.org/ehd
<br /> PUBLIC RECORDS RELEASE APPLICATION
<br /> AP�, BUSINESS/AGENCY: \VSA tt kuldTpSj ,r,la),a
<br /> ADDRESS: �a '�dts(yad Wt±: - CITY/STATE(ZIP: F , ' ra.,v�l CA
<br /> PHONE(1): Clitp- -31z —1434 PHONE (2): FACSIMILE:
<br /> TENTATIVE*APPOINTMENT DATE: Time:
<br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed)
<br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT DATE Z
<br /> Electronic Information: ❑ List❑ Map-Description:
<br /> FILE ADDRESS EHD USE ONLY
<br /> Street# Street Name City ❑,Unit 1
<br /> 1 1,6-m W Gram- i incr Qvotol f ivtoxnkuin llovsc
<br /> 2• Grar1- Linc- R,-A "IS\_0 4wft-frwin n.. Unite
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<br /> 4. 1°13Bg Gra LAriti eVOLd _tAwakul 6—M
<br /> ,(]Unit 3
<br /> 5. 1 q 31. �0!t( ltnl. Po
<br /> 6. 1`T 6'W 2- W cly"- L n d MWAKln V" i]nit 4
<br /> 7. J �df��/cLhzl
<br /> B. Z 23 ❑Unit 5
<br /> 9.
<br /> 10. ❑Unit 6
<br /> Specific Date Range of Information Requested: From to
<br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES
<br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILnYNEH1CLE
<br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE
<br /> ®UNDERGROUND TANK(MONITORINGiREMOVAL) ❑FOOD FACILITY ®DAIRY
<br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT
<br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKiYARDICHEMiCALTOILETS
<br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES
<br /> ❑TATTOOBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS RtOTHER(PLEASE SPECIFY) WC11 0XV( Wt-M
<br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS)
<br /> 1. List ug 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 1209)464-0138 or mail to the address Indicated above. Address
<br /> ranges will not be'accepted-for additional assistance with file addresses,contact the END. Applications received after
<br /> 3:00 pm will be processed the next business day.
<br /> 2. 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new 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 the applicant
<br /> Future file reviews by the same applicant may require a$125 deposit prior to review.
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<br /> EHD 48.06 914112
<br /> Received Time Dec. 13, 2013 2:36PM No. 4764
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