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AUG-14-2014 THU 09:23 AM Moo (wining Associates FAX N0. 5jf68 7126 P. 02 <br /> 'DATE RJ"Gf-gYC }+`v � SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> pUCT 4 2p14 <br /> 1868 EasstOHa ehon A enue, Stockton, CA 95205-6232 qs*3qO <br /> Tele 209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENvWAy <br /> a RMX['S R1t�BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: R'�'Q ve Z- BUSINESSIAGENCY: ("ttvr•e -r- ;., <br /> ADDRESS: 2,527 Ff<5-o Sk,ee.-r CITY/STATEFLP: re s&,w, CA 9,R-7e- <br /> PHONE(1): (SSY) 261? - -702( PHONE(2): (5-511) 478-954_1( FACSIMILE: 6rsl) 2,09- 7(16 <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 REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S//?/Y <br /> Electronic Information: ❑ List❑ map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> SVeet# SVeet Name city ❑Unit s <br /> 1. 135 i J. Fcre� ov\4- dace S4occ�do ZIL(�1i <br /> 2. �oZrpj LJ. fee`-.o n-1- S•i�ree .i- �' .S 46c4.Eo r� J " tR� Unit 2 <br /> 3. 2 �S LJ Fr2r o'1 {,e2f S{ofcLc Fo• <br /> 4 /y-(�.Lf LJ . re.,.or+- c.4,-eC+ .S-fxk4a .. �'�lnit3 <br /> !- a�q 23 <br /> Unt4 <br /> 9 50 ❑unit 6 <br /> 10. I ©1fn146 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> �,U`r�'DERGROUND TANK(UST)CLEANUP SITE(LOP) [�MEDICAL WASTE FACILITY SOLID WASTE FACIUTYNEHICLE <br /> y JTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> _ ,Ly 6NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑jJAIRY <br /> I,.Y],/ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL [3i WASTEWATER TREATMENT PLANT <br /> L1�HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL E]PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> FVTIERED PERMITTED FACILITY �❑]POOLISPA iJ LAND USE APPLICATION SITES <br /> F]TATTOOISODY PIERCING LCI COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPN1(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 file type MUST be selected. Fax to(2091464-0138 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 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 $126 deposit prior to review. 'BOXED AREA-EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete.surf Name: <br /> 4126114 <br /> FYf\dIL11A <br /> Received Time Aug. 14, 2014 9: 14AM No. 6831 <br />