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RjECEIVED <br /> EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY <br /> MAR ] 12014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> EW110NMENTA-H�phone: (209)468-3420 Fax: (209) 464-0138 Web. www.sigov.org/ehd <br /> PEFIMITISERVICE <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: e frl . q BUSINESSIAGENCY: <br /> ADDRESS: 71,4 CITY/STATEIZIP:C" j <br /> PHONE(1): ?_,PHONE (2): c/0[or�J''f�� FACSIMILE: c'Z6r,-?0S^5 <br /> er TENTATIVE*APPOINTMENT DATE: Time: <br /> 5r/d r-� qt/ ((Please alfaw 10 business days from cEate of application submittal-*Tentafive only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$'f25- SH ONLY)-REQUES OCESSED IN 3 BUSINESS DAYS <br /> .SIGNATURE OF APPLICAN DATA <br /> Electronic Information: ❑ Lis Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. 8 2&O A S,,-' 9 9le i0n �, <br /> 2. O s= /o -/ D LSV21 <br /> © unit 2 <br /> 3. <br /> 4' j Dl 0 Unit 3 <br /> 5. <br /> 6. <br /> zunit 4 <br /> 7. <br /> s. <br /> Q unit S <br /> 9. <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> f�WNDERGROUND TANK(UST)CLEANUP SITE(LDP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> UTHER CLEANUP SITE(ICON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY OLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 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 fife 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 /> © Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 914112 <br />