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Feb . 15 . 2013 10449PM Ge on No . 0730 P . 1 <br /> I� DATE RECEIVEDEMD LOG NUMBER . y <br /> SAN JOAQUIN COUNTY � I ` <br /> i I <br /> ®® i I _ t _�1 ENVIRONMENTAL HEALTH DEPARTMENT ; 1) `k, <br /> i 1 , 1868 E= ast Hazelton Avenue , Stockton , CA 95205- 6232 1 A`I 'C i <br /> [- F_ L3 20 = Telephone : (209) 468-3420 Fax : (209) 4640138 Web : www . sjgov . org /ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT : BUSINESS /AGENCY; eCD N (4La—j, c , <br /> ADDRESS : i (, C Goa )' t 6MM= S cZt3-av� CITY/STATE/ lig : COXIII <br /> PHONE (1 ) : I (�) e 51PHONE (2 ) : 6 rtn - �1: q - g �? Gq FACSIMILE . ql(e — � SZdyr� � <br /> TENTAT IVE'z APPQINTMEN T DATE : jyb,r-ck [ 12 Time : <br /> (Pleare allow YIG business days from date of application € ubmittal - Ri'entofive only - must he confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ EST - U1251 ( 1 (CASM� ECK O LY) REQUEST PR0C5SSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z/151- 7& I <br /> Electronic Information : ❑• Dist ❑ Map — De1§ Gription : <br /> FIDE ADDRESS EHD USF ONLY <br /> Street ff Street Name City ❑ Unit 1 <br /> [2m 7 '� ( � Unit 2 <br /> a / <br /> 4a Q0 <br /> 5 . ��� 1/ pc�sl�f'j Vie/ �®�C�,.r� -t�' <br /> � . til r � G /l e /� yi/ Q Unit 4 <br /> 1. � � � `' '/� G�ik (ak <br /> Unit 5 <br /> 9 . <br /> 'lo ❑ Unite <br /> Specific Date Ran goof Information Requested ; From / ; /alb® to <br /> PNVIRONMIENTAL HEALTH DEPARTMENT FILES <br /> t GND€RGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL. WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br /> 6HER CLEANUP SITE (NON •L® P) ❑ IHOUSIN® ABATEM =NT ❑ WASTE TIRE <br /> PDERGROUND TANK (MONITORINGIR€MOVAL) ❑ FOOD FACILITY ❑ DAIRY <br /> OVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br /> HAZARDOOS WASTEIIHAZARDOUS MATERIALS ❑ MOTELIIHOT€L ❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑ TIERED P€RMITTFQ FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIUODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br /> WFLL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY=FRIDAY 9 : 00 AMIZ : 00PM ( EXCLUDING HOLIDAYS ) <br /> 1 . List up to tegaddresses 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 filo 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 EFID staff at the expense of the applicant. <br /> Future file reviovrs by the sante applicant may require a $ 125 deposit priAr to review. y* Bap. 1Ft nc ; HLA 1� � Cl LY <br /> ilii : r `.: ' • 'i - .1 ,' . .�. • • . • - <br /> :.. kr <br /> ? _ <br /> - - <br /> ': k � Fti <br /> lavlcled b Staff ' P :� 6P: „ ] letd. 'StaffName: <br />