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DATE RECEIVED EHD LOG NUMBER <br /> SAN a1OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a � - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> e <br /> 3+ r`- <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: HAFIZA SALEHBHAI BUSINESS/AGENCY: BOARD OF EQUALIZATION <br /> ADDRESS: 121 SPEAR STREET,SUITE 460 CITY/STATE/ZIP:SAN FRANCISCO,CA 94105-1584 <br /> PHONE (1): 415-396-9158 PHONE (2): FACSIMILE:415-356-6298 <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 SEE AT;TACHED:E.RT-nR DATE 516/13 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 'M/Unit 1 <br /> 1. 29081 W BENJAMIN HOLT ST CCKT NN <br /> ' 2, ❑ Unit 2 <br /> 3. <br /> 4, Unit3 <br /> 5. <br /> v <br /> 6, El Unit 4 <br /> 7. <br /> 8, ❑ Unit 5 <br /> 9. <br /> 10. 1 14CCOUNTING <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHI Lkr j r r2 <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE �I �d!���,} ,,Wf� <br /> ❑UNDERGROUND TANK MO NITORINGIREMOVAL)K ®FOOD FACILITY ❑DAIRY qee g(4((�fYl�/Tf `}4 <br /> ❑ABOVEGROUND TANK; ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT y <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. 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 be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. 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_ ***BOXED AREA-EHD USE ONLY*** <br /> 1-14 a 06 fjxe <br /> ❑ Records provided y Sta - PR Complete. Staff Name: ojjdc-� iPmA 7 rof <br /> FHn 4R-ns d f1..1 I1LD/'CI!1-l - tA& 14112 <br />