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DATE RECEIVED EHD LOG NUMBER <br />/ l SAN JOAQUIN COUNTY <br />�I���/ / ENVIRONMENTAL HEALTH DEPARTMENT <br />�Z7 <br />C' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />V <br />PUBLIC RECORDS RELEASE APPLICATION <br />lA <br />Q/C <br />APPLICANT: NICOLE GRABOS BUSINESS/AGENCY <br />ROUX ASSOCIATES INC <br />ADDRESS: 55512T" STREET, SUITE 1725 CITY/STATE/ZIP: OAKLAND, CA 94607 <br />PHONE (1): 415-967-60001415-967-60284PHONE (2): 219-798-3867(CELL) FACSIMILE: 415-967-6001 <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 RE UEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �?(y�tiLj{�,lC� L1�ni!/� r DATE 4/22/15 @ 3:16 PM <br />J <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />.,El Unit 1 <br />t # <br />Street Name <br />City <br />1. <br />6649 j <br />EMBARCADERO <br />STOCKTON <br />�""✓' �� °� v �' <br />r0 -Unit 2 <br />2, <br />3. <br />EU1nit 3 <br />4. <br />,❑.Unit 4 <br />6. <br />7. <br />5 <br />8.0`Unit <br />9. <br />❑-Unit s <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONME TAL HEALTH DEPARTMENT FILES <br />rhUNDERGROUND TANK (UST) CLEANUP SITE (LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) HOUSING ABATEMENT 11 IWASTIETIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) El FOOD FACILITY DAIRY <br />ABOVEGROUND TANK CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED PERMITTED FACILITY POOLISPA LAND USE APPLICATION SITES <br />TATTOWBODY PIERCING COMPLAINTIRESPONSE RECORDS OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 M-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 file 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 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 $125 deposit prior to review. *''BOXED AREA - EHD USE ONLY*** <br />,y. 60 Gd WSOt6 U w o (6qre �n �5i L <br />C�►� %gLI'A Cov®3lfa22%27 C <br />C o c,7 277((aog7g1 (0 cv 'SIS � Co1-4 ate � I e . <br />❑ Records provided by Staff -PPR Complete. Staff Name: <br />EHD 48-06 4128114 <br />