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R TE t` EHD LOG NUMBER <br /> RE <br /> SAN .IOAQUIN COU !��� �� <br /> • FEB 0 9 2016 ENVIRONMENTAL HEALTH DEPARTMENT �J <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENIRONMFMALHEAj—I,ph6ne: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> P,'.,' PUBLIC RECORDS RELEASE APPLICATION) <br /> APPLICANT: �itl1+ t7J�C BUSINESSIAGENCY: /�e.�lt f /iL-�SOcIt;te7S <br /> ADDRESS: �—'7 ' r'Lfultt �✓Aj CITY/STATE/ZIP: �v14C 1')" Cif-PHONE <br /> if- /4 l`Y ' <br /> PHONE(1): 53D=�/IS 7 �5 P14ONE (2): FAX ORE-MAIL: ;; x X,% N'. „v-, <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-$130 FEE(CASH�O��R�CHEpCK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> S NATURE OF APPLICANT Ski ✓1C�P DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> r'&tt /� Nt-1- <br /> ❑Unit 1 <br /> 2. r �N tiI L s s— t ` k ( Lap-CD <br /> 3. I nL It !\ I i \ t NfG ❑Unit z <br /> e <br /> • • , � _ Ibiil�L,���;J^. ❑unit zH <br /> 5. '9Unit3 vFI .j <br /> Ah S LAY <br /> nit 3HM <br /> B• SITE MITIGATION <br /> 9. <br /> 10 ❑Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> ISNOVEGROUND <br /> DERGROUND TANK(MONfTORING/REMOVAL) ❑WASTE TIRE ❑DAIRY,POOUSPA <br /> TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> JETHAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY F-fOMPLAINTIRESPONSE 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 thetype(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 (110) <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. <br /> "'BOXED AREA-EHD USE ONLY" <br /> ��,a a it K S us 164- vlq CID <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br />