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Mar. 7. 2014 12: 35PM • No. 0334 P. 1 <br /> 830IAH3SWV483d <br /> i DAMJIMIv--N3INN0HIAN3 ` sy 'w,�= EIIIQ LOG NIMMsER <br /> SAN JOAQUIN COUNTY <br /> moo L_-O 8VA ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ne: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ®3A '� ( <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: II'( C- BUSIESS/AGENCY:_C,0 - T ASrc� /l _( <br /> ADDRESS: }t.Y(') Ac5(1v41. }H,�ncfvr-eA 1 .lIjfi- ZCL) CITYiSTATE/ZIP: {t`n_lS'� InTr2%(1 C �hCicj <br /> PHONE(1), 1�1 i i( fir, i h x PHONE (2): 5719 9 ( G. i 6y�, FAC SIMILE: �icl<3G 1, <br /> 4 � . <br /> �r ti TENTATIVE*APPOINTMENT DATE: Seyl�k ( i P C (�� F'yMIc � Time: <br /> rl V� (Please allow 10 business days from date of applicati ' submittal-*Tentative only-must be confirmed) <br /> \�S ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> ;ttde? .SIGNATURE OF APPLICANT DATE QS ZQ f` <br /> Electronic information: ❑ List[:];Wap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City hif 1 <br /> 0 1. U r ;CXCA 9 MM <br /> 2' <br /> V N 3. i 1 firms F rJ�� Ncccr�{� <br /> 4' Unit <br /> 6. <br /> Untt 4 <br /> 7. <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10. <br /> Lefunit 8 <br /> Specific Date Range of Information Requested: From V Cky 1\41,5-i- 2c�(O"-OI to -}- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ©.MEDICAL WASTE FACILITY ❑.SOLID WASTE FACILITYNEHICLE 1 f� <br /> [,OTHER CLEANUP SITE(NON-LOP) O HOUSING ABATEMENT El WASTE TIRE % 'I ,C/r�� <br /> [UNDERGROUND TANK(MONITORINGiREMOVAL) El FOOD FACILITY ❑DAIRY <br /> ( 1 <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL Q.WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEMAZARDOUS MATERIALS ElMOTEUHOTEL .Q PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA - 'Q LAND USE APPLICATION SITES <br /> ❑TA7TO0I80DY 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 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 a licant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. BOtO sEoEiLti' <br /> B Ir?r_.cV.W�'1Y <br /> 914112 <br />