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08/20/2014 14: 47 FAX f 002/002 <br /> DATE RECEIVED EFID LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> !JT4 phone: (209) 468-3420 Fax; (209)464-0138 Web: www,sjgov.org/ehd <br /> HEP-PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAw%"1 at�'o I–i a <br /> BUSINE3SIAGENCY: � Co✓`su (+�.� <br /> ADDRESS: av%v%0ck e_ OO CITY/STATE/ZIP: 1 9.2�DC4 Cc <br /> PHONE (1): 2,2 O- PHONE(2): p .1 O O FACSIMILE: <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. 41.% f t� <br /> �N CHECK BOX TO EXPEDITER EST-$125 FEE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS i <br /> SIGNATURE OF APPLICANT _ �� DATE_ <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City El Unit 1 <br /> 21A, Unit 2 <br /> Ll <br /> [�1nit4 <br /> 7. <br /> 8.~ <br /> 9. ❑Unit 5 <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested_ From C9 OD 6 to i^ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> glJNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY/VEHICLE <br /> Q'STHER CLEANUP SITE(NON-LOP) ❑HouslNO ABATEMENT ❑WASTE TIRE <br /> C31NDERGROUND TANK(MONrrORING/REMOVAL) ❑FOOD FACILITY DAIRY <br /> M'ABOVEGROUND TANK ❑CHICKEN RANCH/D00 KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 91IAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> Q TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICA71ON SITES <br /> ❑TATTOOMODY PIERCING ❑COMPLAINT/RESPONSE 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 tan addressee In the space above. $elect the type(s)of filen from the list above by checking the appropriate <br /> box(ea). At least one file type MUST be selected. Fax to(2091464-01313 or mall to the address Indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next buoinoss day, <br /> 2. For assistance In Identifying the nature and content of END records, please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant If any EHD files exlat. An appointment for review will be confirmed approximately ten (10) <br /> days after recelpt of application. The flies 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. " 6QXED AREA-EHD USE ONLY- <br /> 0 Records provided by Staff-PPR Complete. Starr Name: <br /> EHD 4H oo -.�.�— m�a_e�-_�T..®.A,. �,—. <br /> 4(2a/18 <br /> Received Time Aug. 20. 2014 1 : 51PM No, 6814 <br />