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Num:Advanced GeoEnviroiFax:(707)570-1461 To: Fax: +1(209)464-013B Page I of 1 12/04/2015 3:47 PM <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> h, <br /> EN\ARONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> DEC 0 Telephone: (209) 463-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENV!RON NIENTAL HE-hCH FILE COP <br /> P E-_F,Pvii I T/Ow E W 10E,"i PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Rebecca-Natal BUSINESS/AGENCY: A64annpd C-',PnF:nNJrr)nmPnta1 <br /> ADDRESS: 837Shaw Rc);;ri CITY/STATE/ZIP: Stockton ('A / 95?15 <br /> PHONE(1): 209-467-1006 — PHONE(2): FACSIMILE: 209-467-1118 <br /> TENTAT/VE*APPOIN-FMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> FICHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: D List E Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> allnit I <br /> 1. qt I In Li i s P Ayp. tk I Pthronvl <br /> 2. <br /> ,inn Fqqt I _nudsp Ayp I Athror) nit 2 <br /> 3. 17100 Mijrphy__Parkway:� I Athro' 9t k).t 3AIr <br /> 4. <br /> 5. <br /> J,6. <br /> D/Un it 4 <br /> 8. <br /> F-1 unit 5 <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From all ko'/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY WASTE TIRE <br /> FX1 UNDERGROUND TANK(MONITORING/REMOVAL) El DOG KENNEL DAIRY <br /> MX HAZARDOUS WASTE GENERATOR Ej CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑PUMPER TRUCKfYARDICHEMICAL TOILETS <br /> F TATTOO/BODY PIERCING ❑POOUSPA Q LAND USE APPLICATION SITES <br /> F1 MEDICAL WASTE FACILITY Q COMPLAINT 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 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 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 reorganized by EHD staff at the expense of the applicant. <br /> Future fife reviews by the same applicant may require a $125 deposit prior to review. <br /> EHC1 uSr 01"L <br /> Received Time Dec. 4. 2015 3:47PM No, 0128 VIM <br />