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rom:JoeGarrey Fax:(888)869-1312 To: Fax: +1(209)4640138 Page 2 of 2 611 S12013 3:20 <br /> DATE RECEIVED . EHD LOG NUMBER <br /> a SAN .JOAQUIN COUNTY /\ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 U N 1 1868.East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Z0Ulephone: (209)468-3420 Fax: (209)464-0138 Web:uwwro.sjgov.org/ehd <br /> EN'y`+ 'Al�I)=NT`l.H't I PUBLIC RECORDS RELEASE APPLICATION <br /> 5,ffiCEn) <br /> APPLICANT: C ' ? BttSWESSIAGENCY: <br /> ADDRESS: ��� � jZ�/ i .31 L./---ta / l-YA C)TY/STATEJZIP: NVQ(-4i)A 69 �y� <br /> PHONE(1): �' $ tr7�as PHONE(2). FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: JCA p(A�_ i woe la.-'a( Time: <br /> (Please allow 10 business days from date or application submittal-*Tentaa only-must be'conimmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU 25 CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information, ❑ Llst❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# + Street Name city ❑ 1 <br /> C...� '.tom f <br /> 2. (� Av <br /> 'L l � OQC� ❑unn2 <br /> 3. IN ell-\o 'r Ave 4,A IWC <br /> 4. D f a h10a� ��Unit3 2� <br /> 6. <br /> 7 nit 4 <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) El MEDICAL WASTE FACILITY ❑SOLID WASTE FAC NEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HouSiNGABATEMENT E]WASTETIREq fiiPSj0/jW1f"' <br /> IT, <br /> DERGROUND TANK(MONITORINGJREMOVALkL ❑FOOD FACILITY ❑DAIRY ll� <br /> ❑CHICKEN RANCHI Dor.KENNEL ❑WASTEWATER TREATMENT PLA T <br /> ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> RE0 PERMnTED FACILITYoZ, ❑POOL/SRA I]LAND USE APPLICATION SITES <br /> ❑TATToOA3ODY PIERCING 2foMPLAiNrIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORnS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM 5:OOPM(EXCLUDING HOUDAYS) <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)404-0138 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 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 /> 3. A file that isactively 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 fit e reviewsby the same applicant may require a$125 deposit prior to review. " ,,B 13"e.+4Ri~.A°.;E,BAt(SEg"ftL <br /> EHa 08-06 914112«: <br /> Received Time Jun. 18. 201 3;20PM �No9 <br />