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■ <br /> Oct. 28. 2014 9: 14AM AT" ccociates Inc, 1h, 2042 P. 1 <br /> ■ <br /> ■ EHD LOG14UMBER <br /> ■� � �� <br /> 1 -TIED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 2 8 z014. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)454-0138 Web: www.sjgov.org/ehd <br /> �r=�,S ;I,rNVlGES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ok,. I fy.•GL(l BUSINESS/AGENCY: L,1- t-C) n 0 <br /> ADDRESS: Lor-e.- f e J n-: kvc. 9-e-1 CITY/STATE/ZIP: &,tO-5 L/t 7 <br /> PHONE (1): s4 Gj- -7`t''-L' -IPHONE(2); -2,C/q- FACSIMILV- , d(,n_��f,,�anC®,00.410, <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to revlew the requested records. <br /> ❑ CHECK BOXTO EXPEDITE EST 130 FE OR CHECK ONLY)-REQUEST PROCESSED IN 3 USINE S DAYS <br /> SIGNATURE OF APPLICANT DATE ,� <br /> Electronic Information: ❑ List ap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 4 Street Name City ❑unit 1 <br /> 1. �j CSU ftp a n �`. �l"lt�'7 <br /> 2. G�r �'� ` L�-i vYi� Unit 2 i <br /> 3. <br /> 4. �Unit 3 <br /> 5. <br /> 6. ��i / Unit A <br /> 7. <br /> a. ❑Unit 5 <br /> 9. <br /> 10. [�Unit ti <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 FACILITYNEHICLE <br /> ZOTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑Fool)FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> [HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LA"USE APPLICATION SI7E5 <br /> ❑TATTOO/BODY PIERCING ❑COMPLAiNT/RESPONSE 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.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 for a maximum of five business days for review. Appolntments <br /> should be scheduled accordingly. <br /> 4_ Any file not returned in the samo condition as released will be reorganized by EHD staff at the expense of(lie applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. `BOXED APEA-EHD USE ONLY- <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br /> r_HO ae.oe 08/U�ne <br /> Received Time Oct. 28, 2014 9: 15Aivi 1\1o, 7418 <br />