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DATE RECEIVED EHD LOG NUMBER .1pAQUIN COUNTY <br />EcE#` �EID ENVIRONMENTAL HEALTH DEPARTMENT <br />V 1868 East Hazelton Avenue, Stockton, CA 95205-6232 7&tO <br />11 ZNephone: (209) 468-3420 Fax: (209) 4640138 Web: www.sjgov.org/eh <br />-V�UBLIC RECORDS RELEASE APPLICATION <br />El ttiu,ldff <br />nt f' -II CES - <br />APPL1tM Frank Trinidad BUSINESSIAGENCY: Odic Environmental <br />ADDRESS: 3255 Wilshire Blvd #1510 -_� CITY/STATE/ZIP: Los Angeles - <br />PHONE (1): 213-380-0090 PHONE (2): FACSIMILE: 213-380-0505 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - k7enfafive —only- must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH O HECK ONLY) • REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT - DATE g �o// <br />Electronic Information: ❑ List Q Map — Description: <br />FILE ADDRESS EHD USE ONLY <br />Street * Street Name City <br />❑ Unit T <br />1. 2851 S. Airport Way Stockton <br />2. <br />nit 2 <br />3. <br />4. <br />Unit 3 <br />f8. i unit 4 <br />7. <br />B Unit 5 <br />Specific Date Range of Information Requested: From to <br />ENVIRON AL HEALTH DEPARTMENT E=1LE5 <br />UNDERGROUND TANK (UST) CLEANUP' SITE (LOP) EDICAL WASTE FACILITY �5$OLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) HOUSING ABATEMENT WASTE TIRE <br />UNDERGROUND TANK (MONITORiNGIREMOVAL) � FOOD FACILITY DAIRY <br />ABOVEGROUND TANK E] CHICKEN RANCHIDos KENNEL WASTEWATERTREAT MENT PLANT <br />ITATrOOIBODY <br />AZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTEUHOTE:L UMPER TRUCK1YARDICHEMICAL TOILETS <br />IERED PERMITTFD FACILITY ❑ POOL/SPA AND USE APPLICATION SITES <br />PIERCING �COMPLAINTIR)=SPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL ANb SEPTIC PERMIT RECORDS ARE AVAILASLF FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUdING HOLIDAYS) <br />1. List up to ter, addresses In the space above. Select the type(s) of files from the list above by checking the appropriate <br />bax(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 fife addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The 121-11) will notify the applicant if any EHD ffles 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 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 />4_ Any file not returned in the same condition as released will be reorganized by EHD staff atthe expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. 11.10 EIS AREA- EHD USE ONLY-- <br />[ 1 RQrnrric nrnVirlar1 hS, �4""_L]DD I- i—+-. a <br />_Rete v e d Time -Jun, 10. -2014--11:55 R— o. 632 ff Name: <br />