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08/01__ 014 3 : 12 : 15 PM —0400 FAXCOM ANYWHERE PAGE 2 OF 2 <br /> SAN JOAQ UIN COUNTY EHD LOG NUMBER <br /> AUG 0-12014. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 J <br /> rNVIRONMENTALHJAM%phone: (209) 468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Coe-/ �rhr�;h; BUSINESS/AGENCY: <br /> ADDRESS: 1?L� ;Zrj CITY/STATE/ZIP: C�t�Sci:J�� GG1 <br /> PHONE(1): zj, PHONE(2): �//, 311fs-575,4f 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. <br /> ❑ CHECK BOX TO EXPEDITE REQU ST-$12 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE fjZI/J z4 <br /> Electronic Information: ❑ Llst b Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> E]Unit 1 <br /> 2. U <br /> .... ...... ❑unit 2 <br /> 3. <br /> 4. (�, <br /> ....... V' .,E]Unit 3 <br /> 5. <br /> ....... <br /> 6. <br /> �iy <br /> ............. .O Unit 4 <br /> 7. <br /> .... .... <br /> 8. <br /> _. _.-......._...-- —_. Unit 5 <br /> ...........--... ............._. .. __................. <br /> 9. <br /> 10. � <br /> 0 nit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ®MEDICAL WASTE FACILITYSOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ElHOUSING ABATEMENT N WASTE TIRE <br /> [UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> [4ABOVEGROUNO TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> M HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING CK COMPLAINTIRESPONSE 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 un 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.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$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY` <br /> 10 Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48.06 <br /> 4128NI <br /> Received Time Aug. 1, 2014 12: 10PM No. 6725 <br />