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EHD LOG NUMBER DATERECEIVED SAN JOAQUIN COUNTY RECD DEC 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT /"'') l pp 11� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 `,. 57N,,,, Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd PUBLIC RECORDS RELEASE APPLICATION APPLICANT: BUSINESS/AGENCY: F-RI Cc41,11lC(1N(. ADDRESS: .�SUS- 61-LiIIE offlocz Rib. CITYISTATEIZIP: K6VG /VV J- Ir l PHONE(1): -30 210— PHONE(2): FAC IMILE: Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. ❑CHECK BOX TO EXPEDITE REOUE T•5130 F E(CASH R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS AYS SIGNATURE OF APPLICANT �)U DATE 1Z / L' Electronic Information: E] List El Map—Description: FILE ADDRESS 1 _Street M _ _ Street Name_ _ city EHD USE ONLY ❑Unit 1 1—f _ts�� t�A4A& stNU(Dt2. Iq2>1 �Wt 117-1 �1); 2aa Q2�❑Unit 23. �L� ^ " 22zy(az)'r ",PcoIjiV�4. i ' 'I -Z3ss I (oz) (C�Unit 3 5. r - []unIt4 �. y10zoa $ t� unit 5 S (�10. I ❑Unit 6 Specific Date Range of Information Requested: Fromto ENVIRONMENTAL HEALTH DEPARTMENT FILES MUNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHIC� r z) OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE $ 6)e,- Po j-151-15 Q UNDERGROUND TANK(MONITORINGIREIdOVAL)pl- ❑FOOD FACILITY ❑ DAIRY 1 C.O 03 ABOVEGROUND TANK oL CHICKEN RANCH/DOG KENNEL ❑WASTER ATER TRUCKREA RICH PLANT :EJHAZARDOUS WASTEIHAZARDOUS MATERIALS LX. ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) 1. List un to ten addresses in the space above. Select the types)of fates from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 12091464-0138 or mail to the address indicated above. Address ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 2. 3. The EHD will notify the applicant if any EHD f les exist. An appointment for reviewwill be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a S130 deposit prior to review. "'BOXED AREA-EHD USE ONLY"' ALU i 1 r r I� 7y j ;� :) s 51u 7 s ^ ❑ Records provided by Staff-PPR Complete. staff Name: aeleula EHo 40.06