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Ery Trigueiro OakValleyComBank ( 1/1 ) 10/21/2014 10 : 32: 39 AM -0700 <br /> I� <br /> Q ti G <br /> I ■ <br /> ■ <br /> l� <br /> EHD LOG NUMBER <br /> ■■ ENE SAN JOAQUIN COUNTY <br /> 21 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �!! Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> E-N IE@NMENTALH1rA <br /> '� �niT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT- -) 124 Ia It'=t� ,.ffi( BUSINESSIAGENCY: 0AI?' V44-LEX <br /> ADDRESS: C � d70, c'H C..A1 CITYISTATE/ZIP: oof-7o fJ1 CP- <br /> P H 0 N E <br /> P`PHONE (1): (Zj29) s 1 D 4P PHONE (2): FACSIMILE: -787If <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 appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQU $130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE •/(a -1 j14 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. q,5.--- t O 1 f?o ` V_' �F ` ❑Unit 2 + <br /> 3. f 100NILA <br /> 4. ,.,-('J Unit 3 -i <br /> 6. [3-unit 4 <br /> 7. <br /> a. <br /> ❑unit 5 <br /> 9. <br /> 10. ❑unit 6 <br /> Specific Date Range of Infonnation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> F-1ABOVEGROUND TANK F]CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS TIRE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up 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 We 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 notifythe applicant if any EHD flies 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$130 deposit prior to review. -BOXED AREA -EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 46-06 08101/14 <br /> Received Time—Oct, 21. -2014-10: 27AM—No. 7375 <br />