Laserfiche WebLink
08/20/2014 14: 47 FAX (�002/002 <br /> ±� F1717"? 11 <br /> D <br /> DATE RECEIVED EI)i SAN JOAQUIN COUNTY <br /> REG � 'EI <br /> L•" ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ASG 2 O IQhone. (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> a TLNEP.I�tJBLiC RECORDS RELEASE APPLICATION <br /> APPLICAW", o f-0 NO BUSINESS/AGENCY: Cp^Su (1 <br /> ADDRESS: 3312)�) � . 11nnv�o[lC _qi�, Spa CITY/STATE/ZIP: I-�-, ID Ia� <br /> PHONE (1): TJoZ O• $33' X311-5 PHONE(2):_�a a 1 o `,^5093 FACSIMI : <br /> Please allow 10 business days from date of application submittal for the records to be available. y . <br /> Staff will contact you to arrange an appointment data and time to review the requested records. ,I e 4' S/1 <br /> B OHECK BOX TO EXPEDITER EST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS 0-C'"( <br /> / <br /> SIGNATURE OF APPLICANT Ilta DATE Q��011 <br /> Electronic Information: ❑ List❑ Map—Descriptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Sfreet 1i street Name City ❑Unit 1 <br /> 4440�Q Unit2 <br /> I - N 3.'21 �c •gyp urea '✓ iiw <br /> i <br /> - Unit3 <br /> i5. <br /> 6. Uv ! ` ll l3 Li' ALF �3Slj _ 21 __7: nits <br /> 7. <br /> 8. A ❑Unit 6 <br /> 9 GV <br /> 10. <br /> i Unit 8 <br /> Specific Date Range of Information Requested_ FromOD to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES '^ <br /> D'IINDERGROUND TANK(UST)CLEANUP SITE(LOP) F1 MEDICAL WASTE FACIUD' ❑SOLID WASTE FACIUIYNEHICLE // ! <br /> ®'ETHER CLEANUP SITE(NON-LOP) ❑NOUSINO ABATEMENT ❑WASTETIRE <br /> Ur�1�,(NDERGROUND TANK(MONtFORINGIREMOvAL) F1 FOOD FACILITY ❑DAIRY <br /> [D A <br /> BOVEGROUND TANK ❑CHICKEN RANCH(DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> g-RAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MDTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOLETS <br /> ❑TIEREO PERMITTED FACILITY ❑POCUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATrOO[BODY 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 up to ten addresses In the apace above. Select the type(s)of filar from the[let above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mall 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 exlet. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> should be acheduled 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 US€ONLY'"' <br /> -derd RJ2Lr2 r Lbc'6 Z l+d qC <br /> S Seer rt -,rv1 1-,4 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> azar♦ <br /> EHD 4e-oe <br /> Received Time Aug. 20. 2014 1 :51PM No. W4 <br />