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1ME03/01/2014 15:44 FAX 2001/001
<br /> I ■
<br /> I� DATE RECEIV�ED� �-. FILE C011YHD LOG NUMBER
<br /> Ir tL � nJ ) SAN JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 1
<br /> b. 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br /> AUG ,4 "telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.$)gov.org/ehd
<br /> EN�II[ ®tJrr+_14TA 1 S1 $UBLIC RECORDS RELEASE APPLICATION
<br /> APPLICANT: Erin' BUSINESSIAGENCY: Emcma)
<br /> ADDRESS: 1!4S( �2(v�r— r+LrG�'Dr1�, $f, (pQ CITYISTATEf23P: QaCj,-�
<br /> da
<br /> PHONE(1): Tlo-'490-9565 PHONE(2): FACSIMILE: 96-4Q-Q(pm
<br /> TENTATIVE*APPOINTMENT DATE: g/(Lj/2D%L4 Time: 9:30 AH
<br /> (Please allow 10 business days from date of application submittal-•TenWve only-must be confirmed)
<br /> []CHECK BOX TO EXPEDITE REQUEST-$12 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT Q DATE
<br /> Electronic Information: ❑ List❑ Map-Description:
<br /> FILE ADDRESS EHD USE ONLY j
<br /> Setgoc Vt Street Name Chir Unit 1
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<br /> 111-7 _ Nau 'vg- �7qoNipt a
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<br /> ri -"Unit2
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<br /> 4.
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<br /> 5. `.
<br /> 6- p"Unit 4
<br /> 7. iff f
<br /> 8• _ El Unit 6
<br /> 10, p Unit 6
<br /> Specific Date Range of Information Requested: From to
<br /> ENVIRONMF,NTAL HEALTH DEPARTMENT FILES
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<br /> RGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILITYIIIEHK:L R CLEANUP 3RE(NON•LOP) HOUSING ABATEMENT WASTE TIRE
<br /> RGROUND TANK(MONI ORINGIR,EMOVAL) ❑FOOD FACILITY DAIRY
<br /> EGROUND TANK ❑CHICKEN RWHI DOG KENNEL WASTEWATER TREATMENT PLANT
<br /> RDOUS WASfEIHAZARDOUS MATERIALS ❑MOTEIIHOTEL iPumpERTRUCKfYARDICHFmicALToiLEYS
<br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑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)464-0138 r mall 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 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 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 ex ense of the applicant
<br /> Future file reviews by the same applicant may require a$125 deposit prior to review.
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<br /> Received Time Aug, 1, 2014 4:54PM No. 6129
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