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E ,DATE 2ECEIVED EHD LOG NUMBER <br /> �r SAN JOAQUIN COUNTY <br /> RECE IED EhEast Hazelton <br /> HEALTH DEPARTIVtNT ��J�O <br /> (JG. V �I 9868 East Hazelton Avenue, Stockton, CA 95205-6232 / <br /> JUN 1 <br /> 1 2Xophone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br /> uFALTRUBLIC RECORDS RELEASE APPLICATION <br /> Etjjyjulmm­ <br /> APPLItM Frank Trinidad BUSINESS/AGENCY: Odic Environmental <br /> ADDRESS: 3255 Wilshire Blvd#1510 CITY/STATE/ZIP: Los Angeles <br /> PHONE (1): 213-380-0090 PHONE (2): FACSIMILE: 213-380-0505 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be conflrmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH O HECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT y:;�� // DATE <br /> Electronic Information: ❑ List❑ Map—Description: _ <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2, 2651 S,Airport Way Stockton Hrnnar' <br /> / <br /> CD <br /> CU�p <br /> nit 2 <br /> 3. <br /> 4. <br /> Unit 3 <br /> 5. <br /> 6. Zf <br /> 721 Unit 4 I <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10. <br /> 2-Un it 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRON AL HEALTH DEPARTMENT FILES UNDERGROUND <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) EDICAL WASTE FACILITY SOLID WASTE FACIUTYNEHICLE I r <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE I La <br /> UNDERGROUND TANK(MONITORINWREMOVAL) FOOD FACILITY0 DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL gIA5EWATERTTREATMENT PLANT 17 <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL UMPER TRUCKNARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY 0POOL/SPA AND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING COMPLAINTIRESPONSE RECORDS F-1OTHER(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(208)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 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. ...BQ(ED AREA-EHD USE ONLY-' <br /> -1 AST 14LO ¢ usT- o <br /> !o- "-I CIJ s 106 "'5' <br /> � 5-Ivt <br /> :'o 16,nIVA A6n . OVA, 1Ai WL EnReRceeivedd cTnirmey=JunN. 10. =C2iof4F—1D :55FMRO 25aff Name: <br /> / <br /> (y <br /> e/a112 <br />