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DATE RECEIVED 0 0 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> F -.. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 4 "p CE tw, `�- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> FEB 13 2013 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AF'� N =R` Q €wbfh �r BUSINESSiAGENCY: �'Q <br /> ADDRESS: Z°I`7 j �' F}VQ_ CITY/STATE/ZIP: CZ041S , C,f- '79('f '2_ <br /> PHONE (1): 66!?f , CS-7. f7-/_S PHONE (2): :.9? FACSIMILE; X5!1. SC(2. (0 LLD <br /> TENTATIVE`APPOINTMENT DATE: �_l7 Q, Time: ► : <br /> (Please allow 10 business days from date a`p 11 a ion submittal-`Tentative only-must be contirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$1 FE (CAS CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 4 � Street Name city __ ❑Unit 1SERECr-ELS ENE (RD WiPNTECA _ <br /> Unit 2 <br /> 4. <br /> s. <br /> .L I <br /> Unit 4 <br /> 7. <br /> Lsi' <br /> Unit 5. <br /> 0. <br /> -2unit E <br /> specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El MEDICAL WASTE FACILITY SOLID WASTE FACILfrYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) E]HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MON(TORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL E1PUMPER TRUCKiYARDICHEMIcAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATToo/BODY PIERCING /�i 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 (209)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 flies 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 EHD 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 atthe 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 /> El Records provided by Staff-PPR Complete. staff Name: <br /> EHD 4846 5/4/12 <br /> Received Time Feb. 13. 2013 1 , 1.5PM No. 2313 <br />