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rom:Joe Carrey Fax:(888)969-1312 To: Far: +1 (209)464-0138 Page 2 of 2 6118/2013 320 <br /> DATE RECEIVED EHD LOG NUMBER <br /> H. Tey r� SAN JOAQUIN COUNTY <br /> yam, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868.East Hazelton.Avenue, Stockton, CA 95205-6232 <br /> JUN 18 201%lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> ENN"N:A\Il ENT.At_I-;EALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 41P (rr / BUSINESSIAGENCY: t1 a/ M ?✓' <br /> ADDRESS. y4b (i'yd/ ( tryi e gTY/STATEOP: V,! 'r J 1. ' 1-70 7 <br /> PHONE(1): S ��(�dd j PHONE(2): )FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: ,JVA-- FIFA r„ a;:4 4ao" Time: <br /> (Please allow 10 business days from date of application submittal-*Tenfat've only-must be'confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU� . 25 CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT .� DATE 1` t <br /> Electronic Information: ❑ Llst❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ 1 <br /> 2. 6 rL G/ ( oed ❑Untt 2 <br /> 3. (.N �L.Q.,r �h e i UD <br /> `t' 0 f AIOtA ,0'Unit3 <br /> 5. <br /> 6. <br /> 7. nit 4 <br /> 6. , <br /> ❑unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of'Information Requested: From to <br /> ENVIRONMENTAL HEALTH-DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYNEH}cLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE i{ .(.P��-Dl(,QAI3 <br /> f7l <br /> ❑FOOD FACIL" ❑DAIRY 11'^ -7-1-13❑CHICKEN RANCHIDOG.KENNEL ❑WASTEWATER TREAT ENT PLANT <br /> ❑MOTELMOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> RED PERMnTEO FACILRYtk- ❑P OLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOBODY PIERCING MPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONnAY-FRIDAY8.00 AMS:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the spare 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 /> rangeswillnot 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 now application may be <br /> submitted when the file is available. <br /> 4. Any file not returned iu the same condition as released will be reorganized by EHD staff atthe expense of the�jppllcant <br /> Future file reviews by the same applicant may require a$126 deposit prior to review. .., bA1UEro11LY <br /> n�-���:1i �::.�z ����, '�Ir� ..,o-'E3.c_."yzx, .���Y.�-'✓ a � � - � m-dun � � .�'3k_ , b- �r`r, <br /> EHD 48-06 914112 <br /> Received Time Jun. 18. 201 3:20PM No.. 9 <br />