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ED � A <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �N 1 x 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 S 13V <br /> L.NvIFIONME,ITAI HE -- �rfione: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd O o <br /> ortsmIT(SERVICE5 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: pAAusa L BUSINESS/AGENCY: T �P— <br /> ADDRESS: o ' CITY/STATE/ZIP: �A <br /> PHONE(1): - - —l"/iUbr61e- ��F—_tel�o3r. (old <br /> PHONE(2):�W�h j�?9 c(ADg FACSIMILE: ) <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> ❑ �0 <br /> Staff will contact you to arrange an appointment date and time to review the requested records.------ <br /> SIGNATURE OF APPLICANT -- <br /> CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH 0 CHECK ONLY)-REQUEST PROCESSED IN 3B SU INESS DAYS <br /> C <br /> ATE ID /� J <br /> ElecteoniD Infiormafion: List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street#. Street Name City <br /> 1. -f Unit1 � <br /> S7c�C'fG1 7 (A L? U'K h i <br /> 2. o <br /> s Sort <br /> 3 <br /> 4. tu7n ^1P to i-I Unit2 <br /> - <br /> VC.... -Cl Unita <br /> 5• u ~` .''SITE MITIGATION <br /> 7- dUnit 4 <br /> S. PA74k" <br /> 9. <br /> -p unit s <br /> 10. <br /> Specific Date Range of Information Requested: From Unit 6 <br /> ENVIRONMETAL HEALTH DEPARTMENT FILES fo <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) WASTE TIRE <br /> FOOD FACILITY <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL DAIRY <br /> HAZARDOUS WASTEIHAZARDOUs MATERIALS WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTEL/HOTEL PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> POOL/SPA LAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING C. POOL-/SPA <br /> RECORDS <br /> 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 <br /> ranges will not be accepted.Applications received after 3.00 pm well be processed the next business day. Address <br /> 2. For assistance in identifying the nature and cont- <br /> of EHD 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. ***B4OXED AREA-EHD USE ONLY*** <br /> ( /lH-l� •L�M. re k'L%+e.Q F n kr. E! r v 'Iry✓j <br /> �qwq COCA ti7-7 &AY/p— tti 51 G'de. <br /> cQ I 5is M r — <br /> ❑ Ree cords provided by Staff-PPR Complete. watt Name: r r/ <br /> EHD 46-D6 IW�tn dCJ' I5Gz7• <br /> 'S/1 t/75 <br />