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04/28/2015 4 : 23 : 56 PM -040.0 FAXCOM ANYWHERE PAGE 3 OF -3 <br /> .: - !EDAft <br /> SAN JOAQU N COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR 2 9 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENI-ALHEALf in <br /> PERMIT/Sf;RVECES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: MA 1G(J­,,JAV—"J>S BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: c,'1 <br /> PHONE(1): Sl L 4°a `� � 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 13OX TO EXPEDITE REQUEST-$ E (CAShLp CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS DAYS <br /> SIGNATURE OF APPLICANT -' !'�/ Z- DATE f <br /> Electronic information: ❑ List❑ Map`-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. �—I `� j �A �ret�i� ❑Unit <br /> 4. G�v'1 rf i� �C � j✓ \ �L�J� 1 �L(b Q Unita <br /> 5. le-7 Ck_-rfb�­� <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. ©u it s <br /> Specific Date Range of Information Requested: From to -� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> AEIOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEMAZAROOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY [j POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING WJCOMPLAINTIRESPONSE 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(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$130 deposit prior to review. 'BOXED AREA-EHD USE ONLY** <br /> q . .— <br /> I E 11 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Apr. 28. 2015 1 : 23PM No. 8594 0MV14 <br />