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Q■ From: 02/10/2016 15:19 #073 P.001/001 <br /> III0 <br /> � ® �, • �. <br /> ■ EHD LOG NUMBER <br /> �■ i , EIS" SAN JOAQUIN COUNTY <br /> =LoENVIRONMENTAL HEALTH DEPARTMENT rG I <br /> FEB 3 9 2GIB 1868 East Hazelton Avenue, Stockton, CA 95205-6232 A <br /> @3 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> BEw7r0 rILHF.1gJ. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: Y . yiP / <br /> - <br /> 1 f <br /> ADDRESS: r / 551 �JaGVin �P -So / CITY/STATEIZIP: C-VIn f0f,4 ; if <br /> PHONE(!): f S-'�OS—�Id� PHONE (2): 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 appointt date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQ -ST-$1 € SHO CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ Llet❑ a —De rlption: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City a 0 Unit 1 <br /> 1. -7 � �� � AVT �o <br /> 2. CAO nn 2 <br /> 3. !t <br /> t <br /> 4. I�llnit3 p�aJ <br /> S. <br /> 6. ❑Unit 4 <br /> ( 7. <br /> B Unit 5 <br /> 10. � <br /> Specific Date Range of Information Requested: From j 9 qe[> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY EFfICLE O <br /> THER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT E]WASTE TIRE J(�r y <br /> NDERGROUND TANK(MONITORING/REMOVAL)C� El Fool)FACILITY El DAIRY V_-3 2-Z3(/p <br /> ABOVEGROUNDTANK ^ ❑CHICKEN RANCH/DOG KENNEL [:]WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTEIHAZARDOUS MATERIALSOL ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 AM-5:OOPM (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(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will 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 EHD will notifythe applicant if any EHD files exist. An appointmentfor 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 /> 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 may require a$130 deposit prior to review. "'BOXED AREA-EHD USE ONLY"" <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> 08/01114 <br /> EHD 48-06 <br /> Received Time Feb. 10. 2016 3: 18PM 0466 <br />