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DATE RECEIVED SAN <br /> LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PPUBLIC RECORDS RELEASE APPLICATION <br /> A.N n <br /> APPLICANT: JoI1 vt I . JM Citi"IC�e� BUSINESS/AGENCY: Iy-1 © �"In So✓� ASS�C��te S <br /> ADDRESS: `(07 1 VAAS+r;a ( I a4 CITY/STATE/ZIP: LOT. ', CA <br /> PHONE (1): ): cFACSIMILE: (20`f, 33 3- $30 3 <br /> e�444, <br /> Please allow 10 business dos 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 REQUEST 130 F 311 CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATES <br /> Electronic Information: ❑ List❑ ap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> r. Street# Street Name City ❑Unit 1 <br /> 1 (o�o vt O If G <br /> 2 Z�o�c�(� aaj ✓ac _❑Unit <br /> 3 2(OG00 K O �raC <br /> 4. 2_(Dto O 3 `��N ocaJ - -—'k,_C_U _._ _❑Unit 3 <br /> 5. 2JP <br /> s 2(D 800 aN 0" ❑Unit <br /> 7. ZZ 15 C) C M18AAau� r r- <br /> - <br /> ZLkU 44<,4S" OJ Ti' c ❑Unit <br /> s. (syao- e5 ___5�,�t�I�R oq /14 <br /> �.k sf Sc�N l Ee o� 7/a <br /> 10. 151-7b c <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From a.S ear 5 00 Ie to fe 52t t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <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 <br /> F1 HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑POOL/SPA ❑LAND USE APPLICATION SITES ``C <br /> ❑TATT EJiCI ❑COMPLAINVRESPONSE RECORDS Vj OTHER(PLEASE SPECIFY) WCII�W)QQ�jC <br /> CW_QLL AND SEPTIC PERMIT RECORD LARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-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$130 deposit prior to review. **"BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 08/01/14 <br />