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53 p.m. 07-24-2014 1 /1 <br /> SAN JOAQUIN COUNTY cnuwv Numot <br /> 24104 ENVIRONMENTAL HEALTH DEPARTMENT <br /> L-fH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> yawl RMT SERV'"- ephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> _ PUBLIC RECORDS RELEASE APPLICATION <br /> A- <br /> APPLICANT: I� T)tw/� BUS INESSIAGENCY i 6_ 41_ �2_�u�t <br /> pll c nJ( 1f� <br /> ADDRESS: t o�era&kt t)eif Grde sct/ .o-Z CITYISTATEIZIP 90t*-�Onj CA <br /> PHONE(1): PHONE(2):�9��Q�f-�fll3� FACSIMILE: �M)7'W-0 39 <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- iE(C H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DATE yam{ <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name n0 A City 2 ` �� <br /> Unit 1 <br /> 1. 020/& 0. F <br /> 2. D�3 fT D(. ❑Unit 2 <br /> 3. <br /> 4. Unll3 <br /> 5. I <br /> t�(` i �//� (/ <br /> 6. aq EJUnit4 <br /> 7. <br /> 8. <br /> ❑unit 5 <br /> 9. <br /> 1110. <br /> ❑unit 6 <br /> Specific Date Range of Information Requested: From to <br /> r������,,,,,,////// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY El SOLID WASTE FACILRYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT [:1WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ElFOOD FACILITY ElDAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTEIHAZARDOUS MATERIALS ❑ OTELIHOTEL ElPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY OOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE 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 un 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(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(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 /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> ENO 4&OR <br /> Received Time Jul, 24, 2014 4: 03PM No. 6682 4128114 <br />