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T CEI�fED EHD LOG NUMBER <br /> L t SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (%W DEC 2 3 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EEtVHnOoa::,EiT P:L P J"ALTI't <br /> �` '":!a`E PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:RIAV BUSINESS/AGENCY: Q'WCN RSSCcIR(ES, 111G. <br /> ADDRESS: l3b')( ';3?_ CITY/STATE/ZIP: iXes All t,E <br /> PHONE (1): C�\\Q q)j'\ -I'M PHONE(2): FAX ORE-MAIL: (f�(\1Q�� <br /> Please allow 10 business days from date of application submittal for the records to be available. C DYV\ <br /> Staff will contact you to arran a an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITER UES - 130 FEE AS OR C CK �REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT LE'� DATE IZ '23 Ih <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Stttmot Name -fn city <br /> ❑Unit1 <br /> 2 S oN �°1 fRONTp<( tz(� ST�c�TtiN ro��dcJ. (-D <br /> 3. 3233 LOOM\S 1—D S 100'1 N f of " ❑Unit 2 <br /> 4 ti�2� S N 1�1Jy %% �QDtaTP C STnCTbN 11-3t-t5 ❑UnIt 2H <br /> 5. 2--�1 S \,�^d�1 7%\ ?�vg�CeCt-f�b NI L tC�P- �D nit 3 bt <br /> 5 3\\Z \,O�C\, (-D p� S��()F-\T�\v NC� UnIt 3HM <br /> 7. - 2(/I S \N\V 0 0\ ��l'G[� �d S��t-�-I�N nit <br /> Lop* <br /> 7L _(D B1,61TE MITIGATION <br /> 9. <br /> ❑Unit s <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ccrrrryyyyyy������ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) F-1HOUSING ABATEMENT ❑FOOD FACILITY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑WASTE TIRE ❑DAIRY,POOL/SPA <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> ®TIERED PERMITTED FACILITY CgCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW' MONDAY-FRIDAY 8'00 AM-5:o0PM(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.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 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 /> 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$130 deposit prior to review. <br /> —*BOXED AREA-EHD USE ONLY­ <br /> LIP Vrjj4 .t r <br /> CI itii ` LQ. <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br />