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:UN/09/2015/TUE 1,..38. AM FAX No, �, P. 001 ■ + cc■■4TE RECEIVED .,. f IL . EHD LOG NUMBER SAN JOAQUIN COUNTY i■ �iUN 1, 9 7-015 ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ;_,F��_,Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehl PUBLIC RECORDS RELEASE APPLICATION APPLICANT: ` CW �AA ff C�a r}� BUSINESSIAGENCY: Int 5C`1Cc ADDRESS: 1 C 5 Iy 7c'c�-� CITY/STATE/ZIP: PHONE (1): ZOq 59q 5gVj PHONE(2): FACSIMILE: Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an ap intment date and time to review the requested records. 114 CHECK BOX TO EXPEDITE REQUEST F (C R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE SOC �7 Electronic Information: ❑ List❑ Map-Description: FILE ADDRESS EHD USE ONLY Street# Street Name City ❑Unit 1 �. 1 2. D Unit 2- 3. 4 ❑unit 3 5• SITE MITIGATION 6. ❑Unit 4 7. 8. ❑Unit 5 9. b � S' 10. � Unit 6 Specific Date Range of Information Requested: FromGt S moi/` / rxs ass iy(< to I r C-)C44't- ENVIRONMENTAL HEALTH DEP RTMENI FILES n UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE 1j6 �w yA,,r., OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL 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-5:00PM(EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 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. 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will behold 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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** ❑ Records provided by Staff-PPR Complete. Staff Name: ER_ece_i_ved Time=Jun, 9. =2015= 8: 54AN�No, 8912