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DATE RECEIVED EHD LOG NUMBER <br />% <br />� SAN .JOAQUIN COUNTY <br />� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: SHARON FONG BUSINESS/AGENCY: BOARD OF EQUALIZATION <br />ADDRESS: 3321 POWER INN RD. SUITE 210 <br />PHONE (1): 916-227-6788 PHONE (2): <br />CITY/STATEIZIP: SACRAMENTO, CA 95826 <br />FACSIMILE: 916-227-1883 <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 OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT SE ATTACHED LETTIE DATE 5/15/15 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />Street# <br />Street Name <br />City <br />1. <br />2440/S <br />AIRPORT(MFPU) <br />MANTECA <br />❑Unit 2 <br />2. <br />FA0019867; PRO530510 <br />3. <br />❑ Unit 3 <br />4. <br />5. <br />SITE MITIGATION <br />6. <br />❑ Unit4 <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />egg ACCOUNTING <br />10. <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 (MONITORINGIREMOVAL) DOOOD FACILITY ❑ DAIRY <br />❑ ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />❑ HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOMODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ® OTHER -ACCOUNTING RECORDS <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5: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 (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 $125 deposit prior to review. ***BOXED AREA - EHD USE ONLY*** <br />1111 Records provided by Staff -PPR Complete. Staff Name: I <br />�l <br />« <br />