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A <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> Rc,A) ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 hd <br /> U PJB Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT: David Schlotterbeck BUSINESSIAGENCY:Haley&Aldrich, Inc. <br /> ADDRESS: 3187 Redhill Ave.,#155 CITY/STATE/ZIP:Costa Mesa,CA 92626 <br /> PHONE (1): (714)371-1812 PHONE(2):(714)944-4021 FACSIMILE:(714)371-1862 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 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_�O_� DATE 24 August 2012 <br /> Electronic information: El List El map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 Unit I <br /> _W14 <br /> 11" 31100 S.Corral Hollow Road Tracy 11 <br /> 2. 11 f A zruunit 2 q <br /> 3. AIL4 <br /> - ' I <br /> d <br /> 4. / YUnita 7q <br /> ��:eu _4� A-0 <br /> W <br /> 6. a4kr- 4- 7 <br /> 6, A:Unit <br /> 7. <br /> 8, 0 Unit S <br /> 9. <br /> 110. 1 Unit 6 <br /> Specific Date Range of Information Requested: From 1985 to Present Day <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACIVTIYNE�� <br /> 9 1 <br /> Z OTHER CLEANUP SITE(NON-LOP) E]FOOD FACILITY E]WAST hie <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) P", ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR7") ❑CHICKEN RANCH WASTEWATER TREATMENTPLANT <br /> TIERED PERMITTED FACILITY Df,_ ❑MOTELIHOTEL ❑PUMPER TRuCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING F1 POOLISPA ❑LAND USE APPLICATION SITES <br /> F-1 MEDICAL WASTE FACILITY F-1 COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00Am-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 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 /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EHDUSEONLY <br /> Wl <br /> Zd walo?4 taml?WY74 -�=-(P0Wx-7q4n sjr)4), <br />