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04/28/2015 4 : 23 :56 PM -0400 FAXCOM ANYWHERE PAGE 3 OF -3 . <br /> • . EHD LOG NUMBER <br /> rrjir <br /> SAN JOAQU N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR 2 8 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fan: (209)464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENI-AL HEALfH <br /> PE MITISERVICES PUBLIC RECORDS RELEASE APPLICATIO ILE <br /> APPLICANT: A-P-L °J> BUSINESS/AGENCY: <br /> ADDRESS: C FLAS ( 4 ti.( CITY/STATE/ZIP: CA <br /> PHONE(1): O G RHONE(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-$ E {CASH,9 CHECK ONLY)-REQUEST PROCESSED IN 3 BUST ESS DAYS <br /> SIGNATURE OF APPLICANT -'r+~ -'' — DATE ' <br /> Electronic Information: ❑'List❑ Map--.--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑Unit 1 <br /> 2. .,LIQ v-,.Ao ❑Unit 2 <br /> 3. `�jTi° d`� �c C�1 �'I�tta� RAO I gn Cl--Th;14 <br /> 4. AUnit 3 <br /> 5. <br /> Q"nit4 <br /> 7. <br /> 8• it 5 <br /> s. <br /> 10. C C <br /> t Unit B <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY fff SOLID WASTE FACILITYIVEHICLE�11) <br /> OTHER CLEANUP SiTE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY 1�6/ <br /> ABOVEGROUND TANK ❑CHICKEN RANCH]DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS wASTERAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD]CHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY Wompi-AiNTIREsPONSE <br /> OOLISPA F-1LANDUSE APPLICATION SITES <br /> El TATTOO]BODY PIERCING 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 12091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received atter 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 /> ❑ Records provided by Staff-PPR Complete.Staff Name: <br /> Received Time Apr. 28. 2015 1 : 23PM No. 8594 QN1114 <br />