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EHU LUU NUMoen <br />DATE RECEIVED SAN JOAQUIN COUNTY / <br />ENVIRONMENTAL HEALTH DEPARTIvicNT A�in <br />EC E -H AiE D 1868 East Hazelton Avenue, Stockton, CA 95205-6232 V <br />- Telapt one* (209) 468-3420 Fant(209)464=0138 Web: ww gov.org/ehd— <br />MAR 1'2013 <br />i?„ 1_ PUBLIC RECORDS RELEASE APPLICATION <br />)L <br />Zj <br />,r L <br />APFLPI 'A 3E � � � ��,4� y j BUSINESS/AGENCY: 4AFe 5 E L!� //t% J <br />ADDRESS: /aL r`r o /t�d 1e� /CITY/STATEIIZIP: jTZ,,,_ <br />PHONE (1): 7o5 SSS- l J 7 Z PHONE (2): 2 -OT f/63- J -77 / FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - `Tenta live only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQU T.-[ FE (C O C ONL - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />RIr;NATURE OF APPLICANT /7- ` ) c DATE 1 i- 13 <br />Electronic Information: El st ❑ Map -Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street # <br />Street Name <br />City <br />1. <br />PO <br />A/7 U id <br />id C/CION <br />G% J✓ I)1 <br />❑ Unit 2 <br />2 <br />3. <br />A Unit 3 <br />4. <br />5. <br />Pr6nit 4 <br />6. <br />7. <br />❑ Unit 6 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />1 <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 FACILITY/VEHICLE % <br />21THER CLEANUP SITE(NON-LOP) ❑ HOUSING ABATEMENT ❑WASTETIRE 33 f))16; 4' I,A1 5, <br />'UNDERGROUND TANK (MONITORINGIREMOVAL)CJ P6 "3 <br />❑ FOOD FACILITY ❑ DAIRY ��- y' L3 <br />e ABOVEGROUND TANK (D- 11 ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />0 -HAZARDOUS WASTEIHAZARDOUS MATERIALS/ ❑MOTELIHOTEL ❑ PUMPERTRUCKIYARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING 2-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) 464-0138 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_ " BOXED AREA - EHD USE ONLY" <br />-- - <br />E01 16 <br />=provided"by <br />PPR _ <br />Complete. staff Name: <br />9/4112 <br />EHD 48-0B <br />