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ally r� 616'°N AV,� it E10Z 'LZ'9aj 11111 P1A1aaa� <br />TID1 E. b'"Fl/E `' F,—:D r , , : " ' 1 EHD LOG NUMBER <br />SAN JOAQUIN COIIMITY <br />FEB 2 7 2013 ENVIRONMENTAL HEALTH DEPARTMENT - <br />1868 East Hazelton Avenue, Stockton, CA 98205-6232 <br />ENVIrONMEM—if,,LP,Fia-giephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PEPSFI! /SEFit4ICES <br />PUBLIC RECORDS RELEASE APPLICATION , <br />APPLICANT: I V" In yyt S, BUSINESS/AGENCY: <br />ADDRESS: 62-f—`2 S(a ,nv- St CITYISTATEIZIP: <br />PHONE (1): _,tiG: PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: ITA S T14 Time: I :j <br />(Please allow 10 business days from date of PVI n submittal -*Tentative only - must be confirmed) <br />HECK BOX TO EXPEDITE REQUEST- 25 FEE (CA OR HEC NL`() -REQUEST PROCESSED IN 3 BUST 5S DAYS <br />SIGN TURE OF APPLICANTY'Yy+ P ;Zi�sa� DATE '1i <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street li <br />Street Name <br />City <br />1. <br />kKuy <br />el <br />®Unit2 <br />2. <br />3. <br />, .. <br />Am rp gon,- <br />4. <br />—E] Unit 4 <br />6. <br />7. <br />❑Unit 5 <br />8. <br />9. <br />PAO 1\ ,EjUnit6 <br />SRecific Date Range of Information Requested: From �� to -TO:PE� <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SOLID WASTE FAciuTYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT WASTETIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY 4DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENTPLANT <br />HAZARDOUS WASTEINAZARDOUSMATERIALS ❑MOTELMOTEL <br />L ❑ UMPERTRUCKNARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY POOUSPA LARD USE APPLICATION SITES <br />❑TATTOOIBODYPIERCING ComPLAINTIRESPONSE RECORDS ?!OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 Am-5:00pm (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. Anyfile 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 6NLY <br />j:0 Records provided by Staff -PPR Complete. Staff Name:. <br />EHD 48-16 914112 <br />