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ill Jan 22 2014 2: 58PM HP ASERJET FAX P. 1 <br /> 1 ■� p'"� 5q {� <br /> 1. 0P'�s��r V�i„F EHD LOG NUMBER <br /> DATL"REECC SAN JOAQUIN COUNTY '• <br /> JAN 922 Z014- ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> EN IROMERVIC <br /> NME$ C *phons: (209)468-3420 Fax:(209)464-0136 Web: www.Gjgay.drg/ehd <br /> PERPUBLIC RECORDS RELEASE APPLICATION, <br /> APPLICANT: 6y–ea , '-Qsm(j 13USINESSIAGENCY: TES C ervJiron rviPrri--�1 <br /> ADDRESS: fol 2y'd S-I- 2& 4e- Qoo CITYISTATE0P:S--'—y �.+nca'SCc,� CA b ) 65 <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATlVE'APPOINTMENT DATE: Fnbftxe< < 2 2ojN Tlme: <br /> (Please aRmv 10 bush days tom date at rppl on aubmirml--TaMavve ony-must be confined) <br /> ❑CHECK SOX TO EXPEDITE REQUEST-$125 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ) 12L / 2o)�i <br /> Electronic information: ❑List❑ Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Boost Name City El Unit i <br /> I. aO La i$ five- a ro S330 <br /> 3- <br /> 4 Unit 3 <br /> 5. 0 <br /> 6. <br /> ❑Unft4 <br /> 7. eflawl e i <br /> El Units <br /> 9. <br /> 10. ❑Unit e <br /> Spg�clxe Dale Renee of kdorrrratimr Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ANDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑MEDICAI.WP5M FACILITY ❑Sow WASTE FACLJIYIVEHICLE <br /> OTH9tCLEARUPSITE(NON-LOP) ❑HousINDARMEMENT [IWAIITE TIRE <br /> NDERGROumDTmx(MONaMMOIREMOVAL) ❑FOODFACILrN ❑DAlay <br /> oY mula]TANK ❑Ciliwij RANcmf DOG KENNEL ❑WAaTEWATERTREATMEIT PLANT <br /> HAZARDOUS WASTERAZARDOW M1TERW.5 ❑MOTEUHOTEL ❑fIMPERTRUCKITARDWAEWCALTOILETS <br /> TIERED PERwrTED FACIL" - ❑PDDLISPA W LAND USE APPLICATION SITES <br /> TATro BoDy PIERcelo . - ❑CXKANTNMPONSE RECORDS ❑OTHER(PLEASE SPEciyr) <br /> WELL AND SEPTIC PF-RIMT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-6:00pu(ExcLUDINGHowDAYS) <br /> 1. list uD to ten addresses In the space above. Select the typs(s)of fibs from the I€st above by checking the appropriate <br /> box(ss): At least om file type MUST be selacted. Fax to 12091464-0138,or wail to the address I wilcated above Address <br /> ranges will not be accepted-for additional asslslance with ilia addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the meld business day. <br /> 2. The EHD will notiylhe applicant Ifany EHD files exist. An appointment for review will[be coriflnned approximately ten(10) <br /> days atter receipt of application. The files will be held for a maximum of 11ve busbress days for raviaw- Appointments <br /> should be scheduled accordingly. <br /> 3. AOle that Is actively being worked on by EHD staff may not be immedlatnty available for ravlew. A new appllcatlon may be <br /> submitted when the file is avaaebW <br /> 4. Any ilia rot returned in the same condition as released will be reorgin€zed by EHO staff at the wqmnse of the applicant. <br /> Future file reviews by ttie same applicant may require a$125 deposit.prior to review. <br /> ,c. <br /> ENDS eW12 <br /> Received Time Jan. 22. 2014 2 :57PM Ido. 5063 <br />