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;PMAdvanced Advanced GeoEnviroiFax: (707) 570-1467 To: Fax: +1 (209) 464-0138 Page 1 of 1 12/04/2015 3:47 D <br />�0DATE RECEIVED EHD LOG NUMBER <br />I _ i SAN .IOAQUIN COUNTY <br />i■=1r;F: --= VW! ENVIRONMENTAL HEALTH DEPARTMENT <br />NORM � 4— �} tf <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />DEC 0 7 2015 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br />ENb°IROM(.MEIFfTAL HEAI 4 F <br />PER';/I,T(BEgq!r;ES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Rebecca Natal BUSINESS/AGENCY: Ari\/anrari GenEnvironme tal <br />ADDRESS: 817 ch-Aw [Ra;; l CITY/STATE/ZIP: 4tnrktnn / CA / 95915 <br />PHONE (1): 209-467-1006 PHONE (2): FACSIMILE: 209-467-1118 <br />TENTATIVE` APPOINTMENT DATE: Time: <br />(Please al low 10 business days from date of application submittal -*Tentative only- must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST- $125 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY �// <br />'Unit 1 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Street # <br />Street Name <br />City <br />1. <br />X❑ OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />[] WASTE TIRE <br />UFt / <br />❑ DOG KENNEL <br />Q DAIRY <br />0 HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />3. <br />[] TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />LI,.r n <br />- j <br />ElNnit 3 <br />4. <br />LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑x COMPLAINT RECORDS <br />5. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Po'J'}7DU.(0 �C0•p4init4 <br />6. <br />~' <br />Q-'Unit5 <br />8. <br />9. <br />C1t�/ti �9k <br />i�fths <br />10. <br />Specific Date Range of Information Requested: From <br />all <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />X1 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑x SOLID WASTE FACILTLYNEHICLE <br />X❑ OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />[] WASTE TIRE <br />Q UNDERGROUND TANK (MONITOMNG/REMOVAL) <br />❑ DOG KENNEL <br />Q DAIRY <br />0 HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />[] TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />❑ TATTOO/BODY PIERCING <br />❑ POOLISPA <br />LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑x COMPLAINT RECORDS <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />4 <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 the address indicated above. Address <br />ranges will not be accepted -for additional assistance with file addresses, contact the 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 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 at the expense of the applicant. <br />Fururp flip reviews by the same applicant may require a $125 deposit prior to review. <br />1215 <br />%" CO 1777 a oo V (I- dal Do W-ijb'Ael <br />Mill <br />Received Time Dec. 4. 201 3:47PM No.0128 <br />