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DATE RECEIVED • 0 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> Rrr:i�Z"Pv D ENVIRONMENTAL HEALTH DEPARTMENT <br /> rl`yP k' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ! <br /> FEB 13 2013 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd P <br /> PI}tu t l� <br /> , r- 6-rtw PtlBLI''C RECORDS RELEASE APPLICATION <br /> E <br /> a15I�t'ti� r:��I��� <br /> gfr`'#`xl a4c' BUSINESSIAGENCY_fh9nQF <br /> ADDRESS: `vai7 C y[ _ / CITYISTATE/ZIP:�t pJ{ C(} Y (r 2 <br /> PHONE(1): SSQ CS-7 I77 S PHONE (2): FACSIMILE:=� �, <SL(9. 6 UL') <br /> a <br /> TENTATIVE'APPOINTMENT DATE: `J_ 2 I Time: <br /> (Please allow 10 business days from date application submittal•'Tentative only-must be confirmed) <br /> ❑ CHECK BOXTO EXPEDITE REQUEST-$1 FE (CAS CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE <br /> Electronic Information. ❑ List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street 4 Street Name city <br /> --- ❑Unit <br /> 2. — — <br /> 3. Unit 2 <br /> 4. <br /> --- Unit 3 <br /> 6. <br /> 5• <br /> a <br /> 7. i Unit 4 <br /> 8. <br /> g -- ❑Unit 5 <br /> 10. <br /> -e-dnit 5 <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 FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LDP) ❑HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑F000 FACILITY ❑DAIRY <br /> BOVEGROUN1)TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> A2ARDOU5 WASTEIHAZARDOUS MATERIALS ❑MOTELMOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING RCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:OOPM(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(2091 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 notlfythe 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. "-FOXED AREA=EHD.USE ONLY <br /> O Records prouided by Staff-PPR Complete. Staff Name: <br /> eHo 484-5 <br /> Received Time Feb. 13. 2013 1 : 15-PM No. 2313 94/12 <br />