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i:•b 18 1412:46p — p.1 <br /> rr .oe ND, 5216 K 1 <br /> r Feb. 18. 2014 11 :24AM San Joaquin County <br /> EHDLOG NUMBER <br /> DATERE GE jNj D SAN JOAQUIN COUNTY <br /> K� �lrr ENVIRONMENTAL.HEALTH DEPARTMENT ( r <br /> FE6 I 2M,Q a 1888 East Hazelton Avenue, Stockton, CA 95205-6232 1/ <br /> TelepLH 09)468-3420 Fax: (208)464-0138 Web:wwW.sjgov.orglehd <br /> EN�)�aNMEAPuBLiC RECORDS RELEASE APPLICATION <br /> tYISER'j) - <br /> PEP <br /> MM rk2N-t' �i c�_BUSINESSIAGENCY: <br /> APPLICANT:!'T � s h u <br /> C. J' CITYISTATE/ZIP--_ <br /> ,,ADDRI°SS: <br /> 33 FACSIMILE' <br /> PHONE(1): _ 0 551 v Time: <br /> TENT TP1P APPOINTMEN I DATE c /:-, I <br /> 3 (Please allow 10 business days from dela of apForication submittal-'TentadVe only.must be confirmed) <br /> INIB C4_� HECK BOX TO EXPEDITE REQUE -$125 (CASH O LY)- QUEST PROCESSED 1.14 38U IN,E�S/$DAYS <br /> SIGNAUR15OFAPPLICA14T GATE <br /> Tv2 �Jfo2a/ <br /> Electronic information: L List❑Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city I <br /> [4. <br /> 11`l. /l'LLLt_z.t��: <br /> 30 <br /> J <br /> 5. <br /> it4 <br /> C K .,.ij< ❑Units <br /> 9. ( cl,"Ok - ( re <br /> 10. ❑Unit O <br /> Specific oats Range of Information Requested: From to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUNDTARK(UST)CLEANUP SITE(LOP) ❑MEDICALWASTEFACILITY ❑SOLfDWASTE FACILITYMENCLE <br /> VHER CLEANUP SITE(NON-LOP) ❑HOUSINGABATEMENT ❑WASTETIRE <br /> [[[ UNDERGROUND TANK(MONRORIND/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> F�HAtAR000S WASTEMAZARODUS MATERLALS ❑MOTELMOTEL ❑PLIMPER TRUCKIYARDICHEMICAL7o1LET5 <br /> FEI-TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICAnoR SITES <br /> ❑TATT001600YPIERCI413 ❑COMPLAMTIRESPONSE RECORDS E]OTHER[PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVTFW'- MONDAY-FRIDAY 8:00 AM-5:OOPM(]EXCLUDING HOLIDAYS) <br /> 1. Last ug to ten addresses in the space above. Select the Iype(s)of flies from the Ns[above by checking the appropriate <br /> trox(es). At least one fila type MUST be 6e1e09d. Fax fo(2O9)464.0138 ormall to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addressee:contact the EHD. ApplicafionS received after <br /> 3:00 pm will be processed the next business day. <br /> 2, The EHD will notify the applicant If any EHD files exist- An appointment for review will be confirmed approximately ten(10) <br /> days after mceiptof application. The files will be held fora maximum of five business days for review. Appointments <br /> 3. A fife that is actively being worked on by EHD staff may not be immediately available for review. Anew application maybe <br /> submitted when the file is available. <br /> 4. Any Elle not returned in the same condition as released will be reorganized by EHD staff atthe ex enee of the fp—JS cani. <br /> Future file reviews byttiesame applicantmay require a$125deposltprior toreview. L;soXf: 'wREAu. H -5 <br /> ' °Rc'ciirdsi'.rovtop <br /> d:6K5taff=PP.RCornplete;r§tariNarie ' <br /> Received Time Feb. 18. 2014 11 : 31AM No. 5220 17U12. <br />