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f� 1 <br /> DATE RECEIVER i�" [ EHD LOG NUMBER <br /> SAN'JOAQUIN COUNTY �r <br /> i, llljjy" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> FEB 2. 2 20'13Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> `t: �I.`l'.1 PUBLIC RECORDS-RELEASE APPLICATION <br /> APPLICANT: /t°I/c_s yl «/m e BUSINESSIAGENCY: <br /> ADDRESS: �? CITY/STATEIZIP: <br /> PHONE (1): �?c�e�_ c/7s"= S'ic� PHONE (2): 4��j'-yam -zP3 f FACSIMILE: <br /> TENTATIVE*APPOINTMENT,DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$12 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE j,2 1,2 Z <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. <br /> 2. F r fr ❑ Unit 2 <br /> 3.4. <br /> �t(� ❑ Unit 3 <br /> 6. �, <br /> !✓1] � ­12/un it 4 - <br /> 7: <br /> 8. <br /> © Unit 5 <br /> 9. <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> / ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> QUNDER GROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ElSOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS'WASTEIHAZARDOUSMATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TIERED PERMITTED L.yrOOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING COMPLAINTIRESPONSE 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 t6ten 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 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 the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. ***BOXED AREA-EHI]USE ONLY"** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> P , , " 't 2,. _. °2 • 1 ?t rr J� 914112 <br />