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I■ <br />■ <br />I■ <br />r■ DATE RECEIVED SAN JOAQUIN COUNTY END LOG NUMBER <br />�I ■ � <br />■ RECEIV® ENVIRONMENTAL HEALTH DEPARTMENT - <br />1868 East Hazelton Avt:nue, Stockton, CA 95205-6232 <br />MAR 26 201felephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />F <br />�r <br />PUBLIC RECORDS RELEASE APPLICATION <br />APP'LTf8ANT: T ^ L C�SDDj j4& BUSINESSIAGENCY:pRei-Nap— a46 LNWJWI-r <br />ADDRESS: 2``j7 I W LW AR AN2--CITYISTATEIZIP:0jj2j Is-, CA 9 aC�12,L <br />PHONE (1):57. (`7.2S PHONE 2): FACSIMILE: 0 <br />TENTATIVE" APPOINTMENT DATE:' <br />Time: <br />(Please allow 10 business days from da a of application submittal - kTenfative only - must be confirmed) <br />[:]CHECK BOX TO EXPEDITE REQUEST -$125 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BU (NESS D YS <br />SIGNATURE OF APPLICANT DATE / <br />Electronic Information: ❑ List ❑ Map— Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ it 1 <br />Street # <br />Street Name City <br />,.Wr'�c.�y�$ <br />2. <br />y[ <br />Mnn 3"Y5, <br />r , <br />G���%( ❑ U ' 2 <br />P_ <br />V4• L] Unit 3 <br />MN <br />5. <br />_E3Unit 4 <br />6 <br />7. <br />_ <br />E <br />❑ Unit 5 <br />$• <br />�l <br />9. <br />��Un it 6,1 <br />10.�' <br />Specific Date Range oflnfonnation Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY SOLID WASTE FACILITY EHIC�LE! { z <br />�j OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT 5 hI r5 /V�UNDERGROUND TANK (MONRORINGIREMOVALV ❑ FOOD FACILITY A—WASIETiRE <br />DAIRY 161is- Y- G' IV <br />ABOVEGROUND TANKS ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTE1VATERTREATMENT PLANT <br />HAZARDOUS WASTEIHA2ARDOUSMATER1ALA ❑MOTELIHOTEL❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />TIERED PERMITTED FACILITV-, ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTo01BODY PIERCING TKCOMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELLAND 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 listabove by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted -for additional assistance with file addresses, contactthe 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 reviewwill 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 />A. 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 USE ONLY <br />, ,1111 <br />/moi <br />J , l I 1_ <br />o=GL:-1 :=..-r:�alii�li alf•t••l'��r_ I �i�V����-.cam-ti=:��.`:r.�f i::...i - _ <br />EHD 4&o6 --..__ <br />Received Time r. 25, 2014 4:58PM No.5557 <br />in <br />