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■ <br /> ■ <br /> ■ <br /> ■ , ��:Xn <br /> DIERECEIVED ' �;f " .�. EHD LOG NUMBER "'•. <br /> SAN JOAQUIN COUNTY „ <br /> 'COPY <br /> , � <br /> ENVIRONMENTAL HEALTH DEPARTMEN <br /> N-11 3 f� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ ( L� ��% I, f BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: 9 e15f <br /> PHONE (1): aj 5� '?rJ$ /5 001 PHONE(2): FACSIMILE: V S-rog�f� / <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Plaase allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 12 EE H OR C K ON REQUEST PROCESSED IN 3 EUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE r / <br /> Electronic Information: ❑ List❑ Ma escription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street S Street Name City ❑Unit 1 <br /> 2. i <br /> ❑Unit 2 <br /> 3. <br /> 4. <br /> ib Unit 3 <br /> 6. <br /> ❑Unit4 <br /> 7. <br /> 8. <br /> units <br /> 10. �� I ����C I <br /> O Units <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 FACILnYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENTASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) E]FOOD FACILITY DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DoG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> '��AZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEIJHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOBODY PIERCING COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEA$E SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORD$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 appilcant 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. QXEJ' REQ=_.Fi, Uss �?Ni`( <br /> 1 Records provided,by.Staff.PPR.Corhplete.,sr fi Narne. <br /> EHd 4&_06 :.. <br /> 9!4112 <br /> Received Time Aug, 6. 2013 2:08PM No. 3808 <br />