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■■/14/2014 2:46 PM 15597026522 ->12094640138 <br /> C5 1 <br /> ■ <br /> ■■ DATE RECEIN- END LOG NUMBER <br /> :■ p 4} `jl SAN JOAQUIN COUNT <br /> ■ ' ` ,f ENVIRONMENTAL HEALTH DEPARTMENT �± <br /> ■ <br /> 10L 14 2014 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EI _1H <br /> i�1JIRO'NMJTF.L HEPlPUBLIC RECORDS RELEASE APPLICATION <br /> F-r�tX�T F — — - — - - <br /> APPLICANT:� pi N6 BUSINESS/AGENCY: { Q7►J (p <br /> ADDRESS: CITYISTATEIZIP: ►S rA 236tZ <br /> PHONE(1): PHONE(2): FACSIMILE. 559.`10?- E,, <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1 5 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7 11 4flf <br /> Electronic Information: ❑ List[]Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# f Street Name city Q Unit 1 <br /> 2. k <br /> ❑Unit 2 ! " <br /> 4. <br /> EI Unit 3 <br /> ❑Unit 4 <br /> 8. ❑Unit 5 <br /> 'I o. � \ ❑Unit f," <br /> Specific Date Range of Information Requested: From to ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑NEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEiICLE <br /> OTHER CLEANUP SITE(NoN-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MQNITORINGIRE ovAL) ❑FOOD FACILITY XDAJRY <br /> N-ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHF-micAL TOILETS <br /> '0 TIERED PERMITTED FACILITY POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOoIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyIEw: 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.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$125 deposit prior to review- 'BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 4W4 <br /> Received Time Jul. 14. 2014 2:46PM No, 6581 <br />