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05/14/2013 08:27 FAX 9163722565 If IVALLACE-KUHL AND ASSOC. 001
<br /> EHD LOG NUMBER
<br /> �� DAiEREOE . ' SAN .JOAQUIN COUNTY
<br /> r ENVIRONMENTAL HEALTH DEPARTMENT
<br /> MAY .[ 'Z 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd
<br /> E1VV_1.;'11N1 ZNTr4L;iEA 1fi.l
<br /> ('r„F:)ii/SKST ICES PUBLIC RECORDS RELEASE APPLICATION
<br /> APPLICANT- .lµ,.., .IA,nInO BUSINESS/AGENCY: W&IIa -Ic hl Xs- oe
<br /> ADDRESS: CITY/STATE/ZIP:yI•A�i��mmen�ai A 95(ootl
<br /> PHONE(1): 91re-aya.lU I PHONE(2): FACSIMILE: Cilt,-,,!j1a. -aZr,
<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 DATE
<br /> Electronic Information: ❑ List❑ Map- Description:
<br /> FILE ADDRESS END USE ONLY
<br /> Street# Street Name City ❑Unit 1
<br /> 1. Z 60 W Mae Arfiluy Toy nf .404
<br /> 2. Sc,Z ❑unit 2
<br /> 3. �• 2�tS
<br /> 4. ZJiSt(-- .,0Unit3
<br /> 5.
<br /> 6. It Q nit4
<br /> $, ❑unit 5
<br /> s.
<br /> 10, ❑Unit 6
<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 FACILITYNEHICLE
<br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE
<br /> DERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY
<br /> ABOVEGROUND TANK F1CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT
<br /> ,
<br /> AZARDOUSWASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS
<br /> ❑TIERED PERMITTED FACILITY ❑, OUSPA ❑LAND USE APPLICATION SITES
<br /> ❑ INTATTODIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY)
<br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE R REVIEW: MONDAY-FRIDAY 8:00 AM-5:DOPM(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 file reviews by the same applicant may require a$125 deposit prior to review. •„9',R, I�,1,.'" �,(( 'r�1•
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