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DA'Nov, 22. 2013 9:16AM No, 0778 EFP.'`1,NUMBEIR <br />�■ SAN JOAQUIN COUNTY <br />�� ENVIRONMENTAL HEALTH DEPARTMENT <br />■ 1868 East Hazelton Avenue, Stockton, CA 95205-6232( <br />NOV 2013 Telephone: (209) 468-3420 Fax; (209) 464-0138 Web: www.sjgov.org/ehd._ <br />-- <br />HEALTH <br />PUBLIC RECORDS RELEASE APPLICATION <br />APP! iCANT - _F' y1dlceW <br />ADDRESS: IS33 F <br />BUSINESS/AGENCY: <br />CITY/STATE/Zip: <br />1 Pon <br />PHONE (1): ~10�2�(�-48�r" SHONE (2):q Ssd-RZ�& FACSIMILES% -M& S-3 g <br />TENTATIVE" APPOINTMENT DATE: 0L-3 -13 Time: <br />(Please allow 10 busIness days from date of application submittal - *Tentative only - must be confirmed) <br />CHECK BOX TO EXPEDITE REQ�_fPASHEST- $1 5 FEE OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE I(-2` -0 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />r1 ,,, ;t 1 <br />F <br />Street # <br />Street Name <br />City <br />UST HMS r�MM 9� <br />, " <br />M1 ! !❑ Unit 2 <br />2. <br />I S-i-� <br />� 0 C <br />3'I <br />o\ <br />iV moi" <br />Nati 4*'ky r}•;f <br />HMM Unit 3 <br />4' <br />C��- <br />�� ? <br />o <br />Mt�P Unit 4 <br />6' <br />% <br />W t` l� -E/- <br />7. <br />❑ Unit 5 <br />8. <br />8. <br />❑ Unit 6 <br />10. <br />Specific Data Range of Information Requested: From N1 to /J <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NTHER <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) [_]MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICL C�1 Q� <br />CLEANUP SITE (NON -LOP) LI HOUSING ABATEMENT ❑WASTE TIRE ; cC, <br />tIEAZARDOUS <br />❑ TS <br />UNDERGROUND TANK (MONITORINGIRLMOVAL) [:]FOOD FACILITY El DAIRY \ i'�,Iq <br />OVEGROUND TANK El CHICKEN RANCHI DOG KENNEL WASTEWATER TREATMENT PLANT <br />WASTEIHAZARDOUSMATERIALS ElMOTELIHOTELPUMPERTRUCKIYARDICHEM(CALTOILERED PERMITTED FACILITY [] POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINTIRESPONSE PECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 5:00 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 (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 fife 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. �`��y, f <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the Ilcant� "• <br />Future flle reviews by the same applicant may require a $125 deposit prior to review. <br />�Jt ::II'GA, ::L.irt: .,.i,;�Cit'd�''TtAt, .ut ... .. �I�'t,.... i'.. • .. _... .. .. __ .�....-.,. �F'�"^•R1VVdAIMIMIRIRN7IAR':'.._t'1.�5 ,..5°�_I'. ., N, ,!".......,_. <br />Received Timer!Nov. 22.1-120139- 9: 22AWallo.45956� `T <br />EHD 48.06 0j,,"SA 1'&24 Cb ) - PnD-J d CP FM df COOOZ <br />CSP' Hee Fila &,75-Ct1«kj (Nr <br />4" <br />