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DATE RECEIVED *+ EI -ID LOG NUMBER <br />f SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPA <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FEB 13 W3 <br />�4�1u«��t�_�, <br />Fs �,E-rtt �"`I:. BUC /RECORDS RELEASE APPLICATION <br />E�[ <br />I l=..fir <br />,.ilj BUSINESSIAGENCY: <br />ADDRESS: ° . . CITYISTATE/ZIP: C Z,24 {S . Ch- '7334 i -2— <br />PHONE <br />PHONE (1):��i'`-'i. 'r?� 5 PHONE (2): FACSIMILE,�L-) <br />TENTATIVE* APPOINTMENT DATE:9-1 �7 9, Time: <br />(Please allow 10 business days from date & applica ion submittal - 'Tentative only -must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST -$1 FE (CAS CK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE :?= <br />Electronic Information: E]List ❑ Map – Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />[IUnit 1 <br />Street # <br />i Street Name <br />City <br />1. <br />C (a eC Unit 2 <br />2. <br />tp�PtNTECA <br />3. <br />Unit 3 <br />4. <br />5. <br />------ <br />_ <br />Unit 4 <br />6. <br />7. <br />5 <br />8. <br />_..__Ehunit <br />9. <br />nit 6 <br />L 10. fr r (U-,Zd <br />I I LLJ � � <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />DQ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) E]MEDICAL WASTE FACILITY bZSOLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (KION -LOP) ❑ HOUSING ABATEMENT WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />BOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL D<WASTEWATER TREATMENT PLANT <br />AZARDOUS WASTEMAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEMICAL TOILETS <br />TIERED PERMITTED FACILITY POOL/SPA ❑ LAND USE APPLICATION SITES <br />[—I TATTOO/BODY PIERCING COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-S:OOPM (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 f2091 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 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 />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 at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review.-01OXED AREA =E:HD USE ONLY <br />.0 Records provided by Staff -PPR Complete. Staff Name: <br />Keceived Time Feb. 13. 2013 1:...1.b -P -M No. 2313 <br />