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1. • EHD LOG NUMBE <br /> i f3 /S <br /> -17 <br /> SAN aJOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPdRS'' <br /> ism <br /> FEB 2 0 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENTAL 1IEFfL.I-H <br /> PEFIMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �J(e lC l (t�lelb{ P� �ajjgz BUSINESS/AGENCY: <br /> ADDRESS: E , CITY/STATE/ZIP: :5-TOCk c A — CA <br /> PHONE (1): yo -t4q,?.- Qpo PHONE (2): FACSIMILE: <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 REQUES 25 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN_3 BUSINESS DAYS <br /> SIANTU <br /> RE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> ❑Unit 1 <br /> 1. In7 T(&-7b <br /> 2. <br /> 3. ❑Unit 2 <br /> 4. <br /> - c <br /> 5 _�I Unit3 <br /> s. l�/`/nuc-l� Jf <br /> f �L L2 L� UnR4 <br /> 7. � <br /> 8. <br /> 9 [j Unit 5 <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From _ � '0 y2Gl� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑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 un to ten addresses in the space above. Select the type(s)of files from the list above by checing kthe 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. ***BOXED AREA-EHD USE ONLY*"* <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-06 <br /> 914112 <br />