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DATE RECEIVED EHD LOG NUMBERSAN JOAQUIN COUNTY <br /> RECD DEC 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT 79i <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �r'•5�� Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C i CX BUSINESS/AGENCY:_( C LA1JL(0-1 1, <br /> ADDRESS: �)S- (. (_o CITY/STATE/ZIP: /`+L:VO AIV Irl�r <br /> PHONE (1): (,j)u� Z(� (O Z ' PHONE(2): FACSIMILE: <br /> C 6 71 <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 appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUE T-$130 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS BAYS <br /> SIGNATURE OF APPLICANT �f1� .,� ��.�L' _4 DATE ( <br /> Electronic information: ❑ List❑ Map–Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name city <br /> ----�--------- ----=--------- --- ❑Unit 1 <br /> ____ _lam.__._ ._ <br /> 2, I 19 ZI Co I� Iy'Z" �f) ,2.�7 �� Unit 2 <br /> 3. a, 2 2q(07)'� "Z,6Cd J� i tyz 0'0 <br /> 4. i Q�41,UVA T "'t, , I.`�If ZS I (OzJ [9 unit 3 <br /> f <br /> C• _ ❑ Unit <br /> 7. AA +� v c>G3�Ga o �S4 v '�' �/Z0tZ <br /> 8. j ❑Unit s <br /> OL <br /> 10. 1 I ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> CLP <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE tkA*, <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT F1 WASTE TIRE `6 f 1�f Iy v'�"� <br /> U UNDERGROUND TANK(MONITORINGIRELIOVAL),,- ❑FOOD FACILITY El DAIRY 1 (.o Y1-15-15 <br /> ABOVEGROUND TANK J- ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS X, ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND 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 list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or grail 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 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 field 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 /> C %Orli j C � / <br /> :) S /3 - 7;,,- <br /> �- <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4a•06 _�.- 00101114 <br />