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4b131509:34a URS 4 X9261 p.1 <br /> EHD LOG NUMBLH <br /> ;:'E` CEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 13 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 10 <br /> lephone: (209)46&3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> ENVIFIONMENTALHF-ALT14 <br /> PFANY*AbO t PUBLIC RECORDS RELEASE APPLICATION <br /> wilopEF1 1 ��BUSINESSIAGENCY: <br /> APPLICANT.f� <br /> ADDRESS: U, (< i '' r_v cJ � c �lt�-`1ec' CITY'S TATEIZIP: S>r, r✓tCl9�a tv ���j}C� <br /> PHONE (1): 1IIrJ a2�'A �� c� PHONE (2):.,416 -Mn— FACSIMInILe:/� t�G` Tz�I <br /> TENTATIVE'APPOINTMENT DATE: <br /> [Please allow 10 business days fr m da e , application submittal-•Tenfative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE ST $125 E CASH OR CHECK_ ONLY)-REQUEST PROCESSED IN 3 BUSIN S DAYS <br /> SIGNATURE OF APPLICANT �— DATE Z, ' J <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS <br /> 7EHDUSEONLY <br /> Street fl Street Name city E]Unit 1 <br /> c <br /> e 1te <br /> U <br /> ❑ nitz <br /> 2 <br /> 3. a� / <br /> Q]Unit 3 <br /> 4. <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. <br /> ❑unit 5 <br /> 8. <br /> 9. <br /> ❑Unit 6 <br /> 10. <br /> specific Date Range of Information Requested: From T`'1' <br /> �aJtl' rv;c iii to <br /> ENVIRONMENTAL HEALTH DEPART MENT FILES SOLD WASTE FACILITYNEHICLE <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑WASTE TIRE <br /> THER CLEANUP SITE(NON-LOP) ElEl HOUSINGHOUSING ABATEMENT ❑ <br /> UNDERGROUND SITE <br /> (MONITORINGIREMOVAL) ❑FOOD FACILITY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> AZARDOUS WASTEIHAZARDOUSMAIERIALS !D PooSPA�` ❑LAND USE APPLICATION STIES <br /> IERED PERMITTED FACILITY y'IP�'I`' <br /> TATTOOIBODY PIERCING COMPLAIt1T1RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY S:OD AM-$:DOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 2091 464-0136 or mail to the address indicated above. d afters <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. App <br /> 3:00 pm will be processed the next business day. <br /> 2. The END 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 ort by EHD staff may not be immediately available For review. A new application may be <br /> submitted when the file Is available. <br /> ed will be re <br /> 4. Any file not returned in the same condition as releasorganized o EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review, ^`BOxED AREA-EHD USE oNLY`*' <br /> ❑ Records provided by Staff-PPR Complete. staff Name: 91 iliz <br /> _ <br /> Received Time—Feb. 13. 2015_ 8: 04AM No. 8117 <br />