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e 08/06/2014 03:34 5106559517 ENVIRON PAGE 01/01 <br /> i <br /> ■� DATE RECEIVED EHD LOG NUMBER <br /> ■� SAN JOAQUIN COUNTY <br /> ■ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 'AUG'--6 2014 1868 East Hazelton Avenue, Stockton, CA 95205-6232 �1 <br /> Telephone: (209)468-3420 Fax: 209 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: N sylo� V A VI DrA BUSINESSIAGENCY: Er V I KO N <br /> ADDRESS: 2-2DO ?6\AfQl1 4)5+-eTO O r CITYISTATE/ZIP: C vKe r V( G� CA �I 6U S <br /> PHONE(1): 51 U'11ZU 2516(° PHONE (2): N/,A FACSIMILE: 5 `65—451- - <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 REQUES -$125 FEE SH®RE�,Y�,- CIU�E9T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 6--16- <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> C <br /> 3 0 Wesf _ihh Poo 'I-1�aG � tNl <br /> —yk ele — /l/ C Q E)Unit 2 <br /> p� E Unit 3 <br /> 5. <br /> 6. <br /> _ IdUnit 4 <br /> 7. <br /> 8. <br /> 9 _ ❑Unit 5 <br /> 10. / <br /> 1❑Unit 6 <br /> Specific Date Range of Information Requested: From ��. to <br /> ENVIRONMEN AL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID)HASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE 3 � S d fol- <br /> UNDERGROUND TANK(MONITORING/REMOVALDI— ❑FOOD FACILITY DAIRY � <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KEN2 <br /> NEL WASTEWATER TREA NT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIAL ❑MOTELIHOTEL �PUMPERTRUCKIYARDICHEMICALTOILETS 7 <br /> TIERED PERMITTED FACILITY O' ❑POOL/SPA LAND USE APPLICATION SITES <br /> TATTOO/BODY 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 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 END 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 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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> `r- w 5 6) ol- 972, hilt oli <br /> << I� ,i <br /> ❑ Records provided by Staff-PPR Complete.Staff Name: <br /> EHD 4"6 <br /> 4128114 <br /> Received Time Aug, 6. 2014 4: 35PM No- 6758 <br />