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kwk <br /> REC J,) <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY AL <br /> MAR 11 2014 ENVIRONMENTAL HEALTH DEPARTMENT t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMEWAI-Hphone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> pESMITjSERIIICE <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: o �► /h� • o BUSINESSIAGENCY:Z X66{� Z"j <br /> ADDRESS; �CITYISTATI=IZIP: T��`� <br /> PHONE (1): -- -,!!�39j PHONE (2): FACSIMILE: <br /> er TENTATIVE*APPOINTMENT DATE: Time: <br /> r9,,(,W�(Please allow 10 business days from data of appl(cation submittal-*Tentative only•must be confirmed) <br /> /0 <br /> F1 CHECK BOX TO EXPEDITE REQUEST-$125 F SH ONLY)-REQUES OCESSED 1N 3 BUSINESS QAYS <br /> .SIGNATURE OF APPLICAN DATIt <br /> P� <br /> Electronic Information: ❑ Llstfl Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. g 2c�o Al s��J� 9 9 <br /> 2. /1/ D �S= /O -/ D Y;V'S ❑ Unit 2 <br /> 3. z. . / <br /> 4. s Dq' Q Unit 3 <br /> 5. <br /> ❑ Unit 4 <br /> 7. <br /> C3 L61 i a <br /> $. <br /> EI Unit S <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From, to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> UTHER CLEANUP SITE(NON-LOP) [:]HOUSING ABATEMENT E]WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> XF <br /> BOVEGROUND TANK E]CHICKEN RANCHI DOG KENNEL [—]WASTEWATER TREATMENT PLANT <br /> AZARDOUSWASTENAZARDOUSMATERIALS ❑MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> IERED PERMITTED FACILITY OPOLISPA ❑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-5:00PM(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(208)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 END 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 /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 - 914412 <br />