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�* Fro..ARCADIS 714 730 9345 0910 2012 16:51 #023 P.001/001
<br />DATE RECEIVED SAN JOAQUINEHD LOG NUMBER
<br />OUNTY
<br />CE1 ®"1 r ENVIRONMENTAL HEALTH DEPARTMENT
<br />� ,LU12 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br />StN Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd
<br />ENy►RcaylCiH PUBLIC RECORDS RELEASE APPLICATION
<br />APPLICANT: p0�2� %� CLI -✓o p� BUSINESS/AGENCY:
<br />ADDRESS: 32o CoMwl2,C.C. ��� 7-oo CITY/STATE/ZIP: -T_VL..\1th�A� C.%"r `�?_LeoZ
<br />PHONE (1): -q 1 `1 - 2U4V PHONE (2): -[Ili Scj�; --3 "S4p FACSIMILE: -7 I`'I ") 0 CA' S `-(CE)
<br />TENTATIVE" APPOINTMENT DATE: Time:
<br />(Please allow 10 business days from date of application submittal - "Tentative only - must be confirmed)
<br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS
<br />SIGNATURE OF APPLICANT r -;e `�,� DATE C-1 -
<br />Electronic Information: ❑ List ❑ Map - Description:
<br />FILE ADDRESS
<br />EHD USE ONLY
<br />❑Unit 1
<br />Street #
<br />Street Name
<br />City
<br />1'
<br />11� O
<br />v �-
<br />� �oc1t-'ice
<br />�-�, NO lA.i'1i c.J
<br />❑ Unit 2
<br />2.
<br />3.
<br />`
<br />,� Unit3
<br />4.
<br />5.
<br />,p unita
<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 />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 (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY
<br />© ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT
<br />HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS
<br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ 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-5:00PM (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, contactthe 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 file reviews by the same applicant may require a $125 deposit prior to review.
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<br />EHD 46-06 914112
<br />Received Time Sep. 7. 2012 4:52PM No. 1095
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