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lfry Trigueiro OakValleyComBank (1/1) 10/21/2014 10:32:39 AM -0700 <br />Is <br />I■ <br />■ <br />I■ <br />,r END LOG NUMBER <br />Imo■ ! GET- SAN JOAQUIN COUNTY <br />21 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvww.sjgov.org/ehd <br />E-!� PONMENTALHEAL <br />3'-54765RVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSINESS/AGENCY: OAK VAI-Lft (_04,W)"NI TY� <br />ADDRESS: film c H 1A) CITYISTATE/ZIP: C)CK-?rJ Fj ca <br />PHONE (1): e&l PHONE (2): FACSIMILE: (2a);'2_0 -_787L <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 EXP EfDITE REQ U $130 FEE (CASH OR CHECK _ONLY) - REQUEST PROCESSED IN 3 BUSINESSDAYS <br />SIGNATURE OF APPLICANT Z EE _— DATE -10AI <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />Street # Street Name city <br />G. SLI N C e n a4 Au e, <br />o Unit i <br />2. <br />3. <br />�01�-���-1 � <br />I_Unit 3 <br />4. <br />Amit 4 <br />6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />F�qUNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILrrY ❑ SOLID WASTE FACIUTYNEHICLE <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY • <br />❑ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATERTREATMENT PLANT <br />❑ HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUh1PERTRUCK/YARD/CHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:D0PM (EXCLUDING HOLIDAYS) <br />1. Llst 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 END at the number noted above. <br />3. The EHD will notifythe 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 $130 deposit prior to review. *"BOXED AREA - EHD USE ONLY" <br />cords provided by Staff -PPR Complete. Staff Name: <br />Received Time—Oct, 21.-2014-10:27AM—No, 737 <br />