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IN <br /> rFHA LOG NUMBER Dj0I)OV dSAN JOAQUIN COUNTY <br /> rµyN�dl�� 3S ENVIRONMENTAL HEALTH DEPARTMENT - <br /> 6q, d 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> A0�t,02 one: (209)468-3420 t=ax: (209)464-0138 Web: www.sigov.org/ehd <br /> \\S3 PUBLIC RECORDS RELEASE APPLICATION <br /> LICANT-- Abby Racco BUSINESS/AGENCY: sive Pak_Q_epEnvir9nmt?n(al <br /> ADDRESS: 407 W. Oak St. CITY/STATE/ZIP: LQd- CA 9520 <br /> PHONE(1): (209,) 9-0375 - ___, PHONE(2):_C209)_365-3222 FACSIMILE: 369-0377 <br /> Please allow 10 business days from date of application submittal for the,records to be available. <br /> Staff will contact you to arrange nrointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST 9'd5 FEE SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_ RATE 9-1f•14 <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name city El Unit 1 <br /> 1. 18915 N_ Hwy 99 Acarnpo 10,E <br /> 2. 18787 N. Hwy 99 Acampo 3 Fitey QUnit2 iG <br /> 3. ��(v?8 /V . R 1 1• ✓0-n <br /> 4, (9k*4(p /v. 17g w0d(A1 �t3 /q <br /> s. (a Z.Sle I'I <br /> 6. 3�S`D - l�vev�(FrY1 •` / �� �/ �/t nit 4 <br /> 7. " <br /> @. <br /> Unit 6 <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From all aviallahip to <br /> ENVIRONMENTAL_HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SiTa(LOP) ❑MEDICAL WASTE FACILITY Q SOW WASTE FACIIIIY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGWIVIOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCNI Doo KENNEL ❑WASmwATER TREATMENT PLANT <br /> HAZARDOUS WASTPJHAZAROWS MATERIALS ❑MOTELIHOTEL ❑PUAlpERTRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY POOLISPA LAND USE APPLK:AnoN SITES <br /> TATTODIBODY PIERCING COMPLAINVRESPoNsu RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS AR7=AVAILABLE FOR REv1EW: MoNDAY.FRIDAY 8:00 Am-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten Addresses in the space.above. Select the type(&)of fjies 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.Appllcatfons 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 tiles exist An appointment for review will be confirmed approxlmatety ten(10) <br /> days after receipt of application. The(ilea will be held for a maximum of five buairle*!%days for review. ,Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not retumed in the salve condition as released will be reorgantzed 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. 'SOXED AREA-EHD U§,ONLY''*" <br /> t7 Records provided by Staff-PPR Complete..staff Name: <br /> EH6 48-06 428114 <br /> Receivec'Time Sep, 29, 2014 2:43PM No.,-7'164 <br />