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DATE RECEIVED EHD LOG NUMBER ,P+ <br /> SAN.JOAQUIN COUNTY L0 <br /> 18 <br /> ® ENVIRONMENTAL HEALTH DEPARTMENT <br /> RECEIVE . <br /> A E 68 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> AUG 2 a 2013 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ENVI S BUSINESSIAGENCY: r , <br /> APPLR€RW f�I CE ���Z <br /> ADDRESS: P(r) ski 4 CITYISTATE2IP: t,`� } K i d C <br /> PHONE (1 �tCt� �' � ' t��i�t�. PHONE(2): FACSIMIL(G <br /> TEN��APPOINTMENT DATE: Time: <br /> (Please allow 10 business Mys from date of application submittal-`Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU -$12 EE(C SH OR CK LY)-REQUEST PROCESSED IN 3 B SINES DAYS <br /> SIGNATURE OF APPLICANT DATE S 13 <br /> Electronic Information: ❑ List Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city it 1 <br /> L3]Unit <br /> STEPHEN R.CLARK,APPRegSER S CONSULTANT Q Unit 3 <br /> :1 Division,AV P R%1 Realm,CO <br /> STEPHEN R. CLARK, MAI C]unit4 _ <br /> Office: (209)932-0700 1 <br /> Cell: (209)608-0742 <br /> P.O. Box 18=4 FAX:(209)323-5770 Unit 5 <br /> Stockton,CA 9.5201 i?mail:,c_lad;(_a,lar6raprealt;.com / <br /> I/-] Dnit 6 <br /> SpeCitic Date Range of Inlormano0 Keques[ea: rrom <br /> to <br /> ENVIRONMEN AL HEALTH DEPARTMENT FILES ,�.,�'`� <br /> ONDERGROUNDTANK(UST)CLEANUP SITE(LOP) EDICAL WASTE FACILITY {SOLID WASTEFACILITYNEHI LE <br /> THER CLEANUP SITE(NON-LOP) ❑l. OUSINGABATEMENT ����!!! ASTETIRE a�(+flS��l1/t� <br /> NDERGROUNDTANK(MCNITORINGIREMOVAL)�(, COD FACILITY AIRY <br /> PTATToolEoDy <br /> BOVEGROUND TANKS ❑ HICKEN RANCHI DOG KENNEL ASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTEIHA2ARDOUs MATERIALSr� OTELIHOTEL UMPERTRUCKIYARDICHEMICALTOILETS <br /> IERED PERMITTED FACILITY TX �OOLISPA �D USE APPLICATION.SITES <br /> PIERCING COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications 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 receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the File is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff atthe expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review, --BOXED AREA-EHD USE ONLY— <br /> N' -13 • 3 s ; ' <br /> 013' v� ",> s n r <br /> Op r 0 r t. <br /> t3 Re cords provldeTr b�)T��Sptaff=PPf�GOmplet -sta Name: (Q d <br /> EHD 4MG Co� V 'tn/ l to r I / 9/4n2 <br />