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07/25/2013 13:34 925371591 GEOCON CONSULTAV 01/01 <br /> rya`' <br /> LOG NUMBER <br /> '� EiiEDEI/�E 2013 SAN JOAQUIN COUNTY <br /> lUl- 4 N ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Eta'; y,3'rJrrPl `.;G[ .qIe hone: (209 468-3420 Fax: 209)464-0138 Web: vvvvWrsjgov.Org/ehd <br /> IU.. p ) <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: C7EOCON <br /> ADDRESS: &&0I pp_15o 5r21 "� CITYISTATE/ZIP: LdUr=-2Mo2iP, el& q1561:) <br /> x� <br /> PHONE (1): PHONE(2): 20^37/ gam fACSIMILE:��a_$7/^S4/S <br /> TENTATIVE'APPOINTMENT DATE: ��3 f3 Time: /0_2p ,1M <br /> (Ploaso allow 10 business days from d_atd of ap icatlon submittal•'Tentative only-must be confirmed) <br /> .CHECK BOX TO EXPEDITE RF_QUESTT-$ E(CAShI _ GHECK ONLY)• EQUEST PROCESSED IN 3 B SINES DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street K Street Name city ❑Unit 1 <br /> �. SISI U-% (ITif 16TRV_Vr%" S2� AGS <br /> 2. ¢92b 3— t .a. t.1 z°Iln ty -r rzac� ❑Unit 2 // F <br /> 3. <br /> 4. MR-4-C-57❑1!lnit 3 <br /> 5. ?_7= t� • l\� �aE�T 5� TR-aL 7tb)(b <br /> 6• nit4 <br /> 7. o �lll3 <br /> g• f,' ' a ❑Unit$ <br /> 10. - — ❑Unit 6 <br /> Specific Data Ringo of Information Requestod: From ZrA�t-l`�ST to C't312Q �"'T' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IUNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY SOLID WASTE FACILRYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITDRINGIREMOvAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUNDTANK ❑CHICKEN RANCH[DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEMA2AR000S MATERIALS ❑MOTE-MOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITE$ <br /> TATTOOIBOI)Y PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5;00PM (EXCLUDING HOLIDAYS) <br /> 1. List up to ton addresses In the space above. Select the type(s)of files from the list above by chocking the appropriate <br /> box(os). 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 files 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 roorganlzad by EHD staff at the expense of the applicant. <br /> y deposit prior to review. `B_o—F)_F6?aR _A,4EHpZ,,5' ,. .t7F74 <br /> Future file reviews b the same applicant may require a$125 <br /> •�.I,:._tw{Y- _ -,y". . . �. • i.. ;i.*{ra:n':,A'a:.'ie.�1':b:'K):iit!?•',:•':i..^•'' v..('"ipp4.:NC(:/:."if={ Pi•F°!'r:j:>.'ieYu�/:y(�ti.:,^.•."an..i!.�'l.i:n%N1n'y.:�:L;y.�.H,iw'(•ii/ili:5-1i:'$'t=u''blri'f�^•' <br /> .q'r <br /> L7.Records 0toVId$d by'StaffFPPR'Complet'e'['Staff Narno: " S 402 <br /> Received Time Jul- 25. 2013 1 :37PM No, 3687 <br />