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■ <br /> C <br /> �■ DATE RECEIVED LOM - R <br /> iN SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 A <br /> �O\I .l Y Telephone: (209)468-3420 Fax: (209)464-0138 Web;www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> r� <br /> �1PF? ( L1tT ` 'ibV Racco BUSINESS/AGENCY; Live Qak GeoEnvirpnmental <br /> ADDRESS: 407 W_ Oak St CITY/STATEMP:-_L j. CA 95240 <br /> PHONE (1): (209)369-037 _ PHONE(2): (209)365-3222 FACSIMILE: <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 appoJntment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST- FEE( R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 11-17-14 <br /> Electronic Information: ❑List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> [stre6t fi Street Name City , <br /> Unit 1 <br /> �+ <br /> 1. �) S / . L o ti.ar✓ Sa rvvrvi.a.� le?/ �- qrv� N11"i rJ� nkCc �p wv 3 — <br /> 2. 21 O 1 k, v.9 B o-(b'r► G � 1.1'bt'J -` � rv�[L».,_. Unit 2 <br /> 3. ( v43 r= . woo t,v� ca c� p,s ► rxccs� <br /> a. ►99-9 1+ Al. La�.�e- S �-o; t=l,a�P <br /> NAS �� 'unit a M <br /> r, <br /> 5- 1 (0 441 a .`Ut b �• I t F r C-0-t i~ ►J D/fi t' <br /> 6' Elunit d <br /> 7. <br /> 8. Unit 5 <br /> 9. <br /> 10. <br /> Unit 8 <br /> Specific Date Range of Information Requesteo: From 01 rv, to <br /> ENVIRONMENTAL <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ DICWASTE FACAIR�TMENY FILES ❑SOI-11)WASTE FACILMN>HICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HousiNG AsATF-mmIT ❑WASTE TIRE ��1�• <br /> UNDERGROUND TANK(MONrrmNG/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT !�, <br /> HAZARDOUS WASTEAUZARDOUS MATERfAtS ❑MoTEUHoTI L ❑PuMPERTRUCKII(ARD/CttE1V ocAL ToiLEfs <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE AVPLICkT*N SITES <br /> TATTOo(BODY PIERCING COMPLAINT(RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten eddreasos In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 1209)444-013$or mail fo the address Indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm wlil 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 F-HD 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"require a$125 deposit prior to review. ***'50XED AREA-ghQ USE ONLY' <br /> A— <br /> il " r� - <br /> I17 <br /> Cj GO i% iLp+: Jcccta ctc�z FSS- F Li. Pf2�� c9PiCS CPf Q CfZ1U1Cc� rttyE%ryJ`+�� <br /> VV750 Lc✓er c d W44 5 c�cvdb�rdc� .P�vu' S leu cutJ�o;s /1QJ� aa� r iD G wy1 sle.a <br /> lt5r �a- 1��� tsWzr ct, tt Ib�3 Wt�abricti42 <br /> EHD"-08 4/=14 <br /> Received Time Nov, 17. 2014 8: 34AM No. 7563 <br />