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r-T-22-2014 07:33A FROM:GEOPHASE 2095690295 T16411135 P.2 <br /> W F <br /> IC I <br /> �' EHD LOG NUMBER <br /> 41 SAN .JOAQUIN COUNTY <br /> 2 2 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> TT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> F__'NVIRONMENIALHEAL'ei?phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: sbdP, Za-k '1yBUSINESSIAGENCY: 67e414 4?916 <br /> ADDRESS: 44L-diee'X4d'7 &'o CITY/STATE/ZIP: /`7-a/r 005, �) <br /> PHONE(1): �6-� �� `1� PHONE (2): FACSIMILES/,., <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 O Y)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Descr' Kon: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street S Street Name City ❑Unit 1 <br /> 2. ❑Unit 2- <br /> 3. �� `1�fl �I• % <br /> 4. —.. -- El Unit 3 <br /> 1"�v7lt <br /> 6. — -- -- Unit 4_ <br /> 7. <br /> g, ❑unit 5 <br /> 9. <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 FACILITYIVEHICLE <br /> / OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> OUNDERGROUND TANK(MONITORINWREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> �❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑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 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)464-0136 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 flies 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, t^QOXED AREA-^EHD USS ONLY <br /> ❑ Rec .rds prpv10ed by Staff-PPR Complete::staff:Nanie <br /> EHD 48.08 <br /> Received Time Oct. 22, 2014 10: 12AM No. 7387 <br />