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i DA.Nov.22. 2013 9:16AM <br />Itifill <br />1��Cu�1 <br />NOV 2 2 2013 Telephon <br />SAN JOAQUIN COUNTY No. 0778 "ESP, <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />e: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e <br />PUBLIC RECORDS RELEASE APPLICATION <br />ENVIRON M RCALRRI H <br />kllTAgTRVIC <br />CA:CW BUSINESS/AGENCY: Ehvi vonw 'e4 u <br />ADDRESS: I.S3.3 CITY/STATE/Zip: yw q( <br />PHONE (1): �A10^�-�7-i8$� 9�HONE (z);�i S3s�SZ�C2 FACSIMILE:.S6' &9 s. --S-3 g°j <br />TENTATIVE" APPOINTMENT DATE_ Time: <br />(Please allow 10 business days from date of application submittal - *Tentailve only -must be confirmed) <br />CHECK BOX TO EXPEDITE REQUEST - $1 5 FEE SH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: []List[] Map •- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # <br />Street Name <br />City <br />1 <br />1 x^61 <br />Wo - <br />N i w M ;�E] Unit z <br />2. <br />2. <br />1`SJ ` <br />11 <br />W e- C �-fS` <br />3, <br />1 SG(I <br />NDP-�`� oeo�pclri� 3e <br />HMM mfylp Unit 3 <br />4• <br />Ito <br />dV, <br />5. <br />I �I <br />a <br />soR� no cos•(> <br />#,&CA Unit 4 <br />6. <br />1 % ( <br />1/1% C -QT <br />7. <br />❑ Unit 5 <br />8. <br />8. <br />❑ Unit 6 <br />10. <br />Specific Data Range of Information Requested: From toAj <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES , <br />&UNDERGROUND TANK (UST) CLEANUP SITE (LOP) F1 MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLLF: <br />LJ CLEANUP SITE (NON -LOP) HOUSING AUATEMENT F] WASTE TIRE i <br />UNDERGROUND TANK (MONITORING/RCMOVAL) [I FOOL) FACILITY E] DAIRY � i 1� <br />DOVEGROUND TANK El CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT ►1 zoo <br />A7ARDOUS WASTEIHA7ARDOUS MATERIALS LIMOTELMOTEL [j PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 5:00 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 (209) 464-0138 or mail to kho address Indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the END. 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 fife that is actively being worked on by EHD staff may not be immediately available for review. A new application may be'l� <br />submitted when the file is avallable, V <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the ex ense of thea ' Ilcant. \ . <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />K e C e 1 v e d I IMel!N0V. 2Z.132UIj'2 y:22AIV61Vo.47V7RT'I' _aFx' <br />EHD 48.08 � wrj p �2t/Lq�p(' /rr� 1 Ci Lct/'ifil. � Jr, eb ) - PfrV4\aA4 inpq CrF C&CO07. <br />�CDdI �C�}�j1pOp FOC- C_OM2-3-71 % , V�G)('(� GiP'_ J I' S of- //fuel FIIC IG 7S C't7(' Yj (A)l` <br />