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IV Feb, 15' 2013 10:49PM Geo No, 0730 P. 1 <br /> I <br /> EHD LOG NUMBER,DA"fE RECEIVED E , <br /> 1 ■ �� ,�� ���, '� _�' , ' SAN JOAQUIN COUNTY <br /> �`'" ENVIRONMENTAL HEALTH DEPARTMENT ° <br /> 1868 East Hazelton Avenue. Stockton, CA 95205-6232 <br /> 1-FB Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: yAA,L1-� BUSINESSIAGENCY: 9a)CI,.n <br /> ADDRESS: �li(,p �p�\rla�(z�, CITY/STATE/ZIP: ��,t�j Cmrp(t��i C��S7yL <br /> PHONE (1): PHONE (2): epL) FACSIMILE: - 3-5a —Y13 2, <br /> TENTATIVE*APPOINTMENT DATE: lytyrcl.. [,2aE2Time: 4'd0 D wt <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHI=CK OOX TO EXPEDITE REQ EST-$125 F= r=(CASH ECK O LY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑•List❑ Map—Description: <br /> FILE ADDRESS EHID USB ONLY <br /> Street# Street Name City Unit 1 <br /> [2. <br /> �`L�^� (, a '��/V� Unit 2 <br /> 3. i <br /> I <br /> 4. QO LCfU <br /> nitaiT1 <br /> Afl^�- ! --' ale �-- <br /> s. � zr � l �e ��,✓ �� ❑ Uhlt 4 <br /> 7. 760 <br /> $ Fj Unit 6 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of information Requested: Prom / i /aISD to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> rid NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> U- HER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRB <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY E]DAIRY <br /> OVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELI_AND SEPTIC PERMIT RECOPDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5'OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ton 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 abov . 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 YAII be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a S125 deposit prior to review.j. <br /> j*t3•'o; p:;ARa'R;tFib uSE�: tv <br /> fitf' <br /> • i <br /> Rcc rds ta..v.Ided b.. .Staff-PPF..':Co►t plete.siff <br /> Q... :. p . Y e-uaz <br /> Received Time Feb. 15' 2013 10:47AM No, 2324 <br />