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JRN-21-1996 11:07 P.02i02 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN OUNTY <br /> RECENED ENVIRONMENTAL HEALTH DEPARTMENT µ <br /> 1868 East Hazelton Avenue, Stockton, CA 95206-6232 <br /> OCT 2 1201 ) ( )9 s d <br /> elephone: 209 468-3420 Fax: 209)464-0138 Web: www.s' ov.or /eh � <br /> EWFjONMENTALHEALTH .PUBLIC RECORDS RELEASE APPLICATION � I L E <br /> pFRMITIauff ES - ---- <br /> APPLICANT:�bb 3 BUSINESS/AGENCY: <br /> ADDRESS: l o °l C:� a"Ka c. \00 CITY/STATE/ZIP: <br /> PHONE(1): ��1a �2Z-S�1 PHONE (2): FACSIMILE: `>kb- 22.'~ ��31 <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-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 10 ( l� <br /> Electronic Information: ❑ List❑ Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street iiStreet Name City - - ( - ELI]Unit 1 <br /> t v`1y� ►�A\�r►. C7�aOIL <br /> 2. Z1 Unit 2 <br /> 3. - <br /> 4. Unit 3 Ii) <br /> 7. <br /> 8. -...•- _ _ Q Unit 5 <br /> s. <br /> 10. EfUnit 6 <br /> Specific Date Range of information Requested: From 1 l 9 qto \ 2 O\ ^ <br /> ENVIRONMENT L HEALTH DEPARTMENT FILES p <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY OLID WASTE FACIL"IVEHICLE <br /> RHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT Rt*ASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK 171CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 1�04ARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUHOTEL L]PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> IERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING �OMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses In the space above. Select the type($)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 flies 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-EHD USE ONLY••• <br /> t l Ror %reUm nrevuld-rill Iagff.PpR Cpmnlatd_ Staff Namet <br /> Received Time—Oct. 2. =2013-11 :46*N No. 4197 914112 <br /> TOTAL P.02 <br />