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�mINH/09/2015ME 11 : 38_ AM FAX 1do, P. 001 <br /> I RECEIVED Z�TE REC EHD LOG NUMBER <br /> , .,'� <br /> SAN JOAQUIN COUNTY FIL <br /> [ME i U N 9 t" Z F,0"i ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East.Hazelton Avenue, Stockton, CA 95205-6232 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �Guu 1.4 C-1-a BUSINESSIAGENCY: <br /> ADDRESS: 1 5 ), Surf CITY/STATE/ZIP: a4- q5z.,2_ <br /> PHONE(1): Z_oq 5% 3q2�1 — .PHONE(2): FACSIMILE: <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 apaintment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQUEST F C R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT— DATE <br /> Electronic Information: ❑ List❑ Map—DescripWon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city 0 Unit I <br /> 1. 10 e,r /w "e <br /> 2. unit 2 <br /> 3. <br /> 4. ElUnit 2l <br /> 5. SITE MITIGATION <br /> 6. El Onit 4 <br /> 7. <br /> 8. El Unit 5 <br /> 9. fl X, <br /> 10. bl(01(5 Unit 6 1 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FAcILITYIVEHICLE <br /> -OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> ,UNDERGROUND TANK(MONFORINGIREMOVAL) F-1 FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/Dor.KENNEL El WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WAsTFJHAzARDouS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUcKNARDICHEMicAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> F]TATTOoIBODY PIERCING E]COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00Am-5:00Pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ton 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 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 ton(10) <br /> days after receipt of application. The files will be hold 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 /> 4 <br /> �4 <br /> 103 Records provided by Staff-PPR Complete. Staff Name: <br /> 1R_ec.eJ_ved Time=Jun, 9, --:2015= 8:54AN/�--No. 8918 wi1/15 I <br />