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FrocMarcus H. Bole & Associat* 530+633+0119 1OA42012 15:21 #257 P.001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY eP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:vwvw.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: L /1 BUSINESS/AGENCY:—RQ te- t- �o Ct{k—'Z:-- <br /> ADDRESS: �� "1 ��cc� D� CITY/STATE/ZIP: (A-AAM a, QIj rJ <br /> PHONE(1): !15 ((/(y),3 PHONE(2): 30 b_3 011 FACSIMILE: 15- d'32 0//j <br /> TENTATIVE'APPOINTMENT DATE: "u / Time: <br /> AAVY <br /> (Please allow 10 business days from d to of application submittal-`Tenta a only-must be con rrned) <br /> ❑CHECK BOX TO EXPEDITE REQU -$1 E C SH O CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 1. 3 W int- Wr a <br /> 2. I _ Ounit 2 1 <br /> 3. ' <br /> 4. Jr �j5 T, nIt 3 l <br /> 6. LVL-[ GID e, Y /QS " (.b1 vP fel 4.11 unit 4 <br /> 7. ! h JG rPl- la4el <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10, nit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> &EFRteRouND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY .�❑SOLO WASTE FACILITYIVEHICLENUP SITE(NON-LOP) ❑HOUSING ABATEMENT , rASTE TRE <br /> ND TANK(MONiTDRINGIREMDVAL) ❑FOOD FACILITY ❑DAIRY <br /> ND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMiENT PLANT <br /> WASTENAZARDOUS MATERIALS ❑MOTELMOTEL ❑PUMPER TRUCK/YARWCMMCALTOILETS <br /> ❑TIERED PERMITTED FACILITY POOL/SPA ❑LAND USE APPLI A71ON SiTES <br /> ❑TATTOO/BODY PIERCING CNclroMPLAINTIRESPONSE RECORDS C]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 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 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 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 thea plicant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> NMI <br /> EHo"-as 9/4M2 <br /> T mo n�+ �Q )(119 111PM No. 1474 <br />