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• Oct. 28. 2014 9: 14AM AT0cociates Inc, 41 No. 2042 P. 1 <br /> VED <br /> FEVE1 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 2 S 2014 1868 East Hazelton Avenue, Stookton, CA 96205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTALHEALTH <br /> F A I ERVICESCPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 0kr-, 3JN "O-n -2 r4 <br /> r, BUSINESS/AGENCY: (f1�r I n 6 <br /> ADDRESS: � Lot-", i e V.C., ale <br /> -ejl CITY/STATEIZIP: � ,1,1Q.S� � <br /> PHONE (1): .1-G iu--Sa q-7q--L' 2-1PHONE(2): Eco- FACSIMILE:d t'n. an'q,Cc.ro(no, <br /> Please allow 10 business days from date of application submittal for the records to be available, Cor <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EYPEDITE EST 130 FE SW OR CHECK ONLY)-REQUEST PROCESSED IN 3 EIUSINEISS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: E] List ap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City unit <br /> 2. Ar (- p unite I/ <br /> 3. IO2j1�1LA <br /> 4- UnIt 3 <br /> 5. <br /> 6. 10 fit (! Unit4 <br /> 7. <br /> 6• ❑units <br /> 9. <br /> 10. Q unit 6 <br /> Speclflc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [!].'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILDYNEHICLE <br /> RrOTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT El WASTE TIRE <br /> [g UNDERGROUND TAN K(MONITORINGIREMOVAL) ❑FOOD FACILITY E]DAIRY <br /> []ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> []-"HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PLIWERTRUCKNARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOL.ISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEAEESPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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(2091464-0138 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 flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held fora maximum of five business days for review. Appo lntmehfs <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released vAII he reorganized by EHD staff at the expehee of the applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHo U-06 08lU+I+* <br /> Received Time Oct. 28. 2014 9: 15AM No. 1418 <br />