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01 / 01 / 2012 03 : 35 FAX _ QJ001 <br /> 1� I <br /> ■ <br /> I■ DATE RECEIVED <br /> EHD LOG NUMBER <br /> IE SAN JOAQUIN COUNTY <br /> dNENVIRONMENTAI_ HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone : (209) 468-3420 Fax: (209) 464-0138 Web ' vAvw. sjgov.org/and <br /> PUBLIC RECORDS RELEASE APPLICATION fy <br /> III w <br /> APPLICANT AMPCCG T KH' J 1�- loo BUSINESS/AGENCY: <br /> ADDRESS {_l_�Z[I '� b LAS I ? CITYISTTATE/ZIP : <br /> PHON (1 ) : =9(Zr� PHONE (2):d ���q - ,1�15A939 FACSIMILE : <br /> Please allow 10 business days from date of application submittal for the r000rds to be available . <br /> Staff will contact you to arrange an appointment data and time to review the requested records. <br /> I CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) • REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SI ATURE OF APPLICANT a-- o DATE <br /> E leetronic Information : ® List O Map a Ddscrlptlon : <br /> FILE ADDRESS EHD USE ONLY <br /> Street B Street Name City <br /> 1 . _. . ISO G <br /> 2. I I C UnIl2 <br /> 3• <br /> 4. ( nek U Y2 e e� 1ti N (1 �( l Unita \� <br /> SA ul <br /> L <br /> _ c_�" S' u c <br /> — vw Q.. D"units <br /> ^ _ b eta circ Shu rl <br /> 5 3 a S3„ .� ) ET nits <br /> ific Data Range of information Raquas ed: From to <br /> TV <br /> ENVIRONMENTAL HEALtrH DEPARIMSNT FILES <br /> ® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) MEDICAL WASTE FACILITY r® SOLID WASTE FACILnYNEHICLE <br /> ® OTHER CLEANUP SITE (NON°LOP) HOUSING ABATEMENT LCA WASTE TIRE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) FOOD FACILITY r❑r--11 DAIRY <br /> A®ovECROUND TANK CHICKEN RANCH/ DOG KENNEL 1] WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUSMATERIALS ❑ MDTEIIHOTEL PUMPERTRUCKIYARDICHEM[CALTOILETS <br /> TIERED PERMITTED FACILRY ❑ POOLISPA 9 LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING N COMPLAINTIRESPONSE RECORDS E] 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 ken addroases In the space above. Select the type(s) of files from the list above by checking the appropriate <br /> box(ea). At least one file typo MUST be selected. Fax to (208 484 0138 or Mail to the addrea® ndleated abave Address <br /> ranges will not be accepted. Applications received after 3:00 pm will be processed the next buelness day. <br /> 2. For assistance b1 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 exlat. An appointment for review will be confirmed approximately ten (10) <br /> days after r000lpt of application . The files will be held for a maximum of five bualness days for review. Appointments <br /> should be schoduled accordingly. <br /> 4. Any file not returned in the came condition as released will he reorganized by END staff at the expenaa of the applicant. <br /> Future file reviews by the same applicant may require a $130 deposit prior to review. "••B9XEO AREq • E.d.p USE QNLY'°� <br /> ,5 / L r/ <br /> /iii -.L�-r-✓� �rl '� [ W J..- <br /> Records provided by StaffwPPR Complete, Statf Nama: <br /> 1±115 .iJ.pti <br /> Received Time Nov , 11 . 2014 7 : 47PM 1109 7525 <br />