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EHD LOG NUMBER <br /> DATE RECEI ED <br /> SAN JOAQUIN COUNTY 0L. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 17 2015 1868 East Hazelton Avenue,.Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> e"FIONMENTAL HE110"H PUBLIC RECORDS R.ELEASE APPLICATION <br /> AM-1 .... <br /> �A&IT: ..." rv.-I"L 111,- <br /> ADDRESS: Rf-Wef -T-122 Vii' &4-'f CITY/STATE/ZIP. <br /> FACSIMILE: mc';p <br /> PHONE(i): PHONE (2): <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 review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> g <br /> SIGNATURE OF APPLICANT— f C,� DATE i <br /> Electronic Information: ❑ List D Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> vuliti <br /> 3. ( �' C) _Z"2�_.J F Q Unit 2 <br /> 0 unit 2H <br /> F4. <br /> 55. [I Unit 3 <br /> 6. <br /> Ej Unit 4 <br /> 7. <br /> ❑SITE MITIGATION <br /> 8. + <br /> 9. <br /> ❑Unit <br /> 10 I to <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑ El HOUSING ABATEMENT Fj WASTE TIRE <br /> ❑OTHER CLEANUP SITE(NON LOP) SLFOOD FACILITY ❑DAIRY <br /> Fj UNDERGROUND TANK(MONITORING/REMOVAL) F�CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑ABOVEGROUND TANK F❑]PUMPER TRUCKIYARD/CHEMICALToiLETS <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL LAND USE APPLICATION SITES <br /> F-1 TIERED PERMITTED FACILITY POOLISPA -4—. . <br /> COMPLAINT/RESPONSE RECORDS OTHER(PLEASE SPECIFY) nel <br /> F-1 TATTOOIBODY PIERCING <br /> WELL AND SEPTIC PERMIT.RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AMr5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type()) of files from list above by checking the appropriate <br /> �oxx(es). At least one file type MUST be selected. Fax to(209)464-0138 omail 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 files exist. An appointment for review will be confi'rmed approxim4tely ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appoinitments <br /> should be scheduled accordingly. <br /> -ihe same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> 4. Any file not returned in * <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. **BOXED AREA--EHD USE ONLY*" <br /> I El Records provided by Staff-PPR Complete. Staff Name: - ----------- <br /> 7/1/15 <br /> EHD 48-06 <br />