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04/28/2015 4 : 23 : 56 PM -0400 FAXCOM ANYWHERE PAGE 3 OF .3 <br /> cm--r <br /> ID, 1RQEIVEJ3r tU,�7t,, C4�,,ZEHD LOG NUMBER <br /> SAN JOA'Q' IAN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR 29 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: wvAv.sjgov.org1ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: MA�L BUSINESS/AGENCY; <br /> CITYISTATE/Z[P: <br /> ADDRESS: TDD1_)61LA15 `W 1_y D t-7,cl(:;�y1ut C_� q5 'U/ <br /> PHONE(1): 1" PHONE (2): FACSIMILE: <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-$1301!fP(CASA© CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS DAYS <br /> SIGN ATI PRE OF Ar rm L I CANT NIT �jt <br /> 1j, 11Wr%1%j Lim I F_ <br /> Electronic information: E] List E] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit I <br /> 2. D Unit 2 <br /> 4. <br /> L-1-b Unit 3- <br /> 5. C <br /> L <br /> 6. bnIt 4 El <br /> jam.].A-D <br /> 7. <br /> 8. E] unit 5 <br /> 9. <br /> 10. <br /> El Unit 6 1 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY f9SOUD WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> 1UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL Ll WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE1HA7AR0OUS MATERIALS El MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEmicAL TOILETS <br /> 171 TIERED PERMITTED FACILITY POOLISPA ❑LAND USE APPLICATION SITES <br /> F-1 TArroo/Booy PIERCING WOMPLAINTIRESPONSE RECORDS E]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(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 riles will be held for a maximum of flys 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. '.BOXED AREA-EHD USE ONLY*** <br /> p(o�Lkek Cat% `fi rj" 'h <br /> ,�Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Apr. 28, 2015 1 : 23PM No. 8594 OM1114 <br />