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02/10/2016 15:19 #073 P.001 /001 <br /> fi <br /> f Q <br /> N K g Fes°[ EHD LOG NUMBER <br /> i�E C�.3k' !&�"`G&�� SAN JOAQU(N COUNTY <br /> • ENVIRONMENTAL HEALTH DEPARTMENT sR ft <br /> FED 1 1 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 IL <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> e4RDNMENT-ALHERtTH <br /> PER rmsERyiCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � �. /xaP_ BUSINESS/AGENCY: Gv C � <br /> ADDRESS: 1 SI JGL tr i/S l7 YP '-7>n / CITYISTATEMP: <br /> PHONE(1): �r �S-�jOS�1C� PHONE (2): -� 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 appoint tdate and time to review the requested records. <br /> E3 CHECK BOX TO EXPEDITE REQ ST-$1 SH O\,CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ z —De ription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑unit 1 <br /> 1. -70 7 <br /> 2• nit 2 <br /> 3. tle <br /> 'yt 1) <br /> 4• nil <br /> 5. D*15 <br /> 6• ❑Unit 4 <br /> 7. <br /> 8. <br /> ❑unit 5 <br /> 9. �i i ti Cj CIA. <br /> 10. � <br /> Specific Date Range of Information Requested: From / 9 In to Pr-,- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 17FUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> FATHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> VAJNDERGROUND TANK(MONrrORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK [:1 CHICKEN RANCH/DOG KENNEL [:]WASTEWATER TREATMENT PLANT <br /> ,fiAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:OOPM (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 12091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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 /> 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$130 deposit prior to review. "'BOXED AREA-EHD USE ONLY*" <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4H fi 08/01114 <br /> Received Time Feb. 10. 2016 3: 18PM^. 0466 <br />