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t ECEIVED <br /> DATE RECEIVED 0 SAN JOAQUIN COUNTY • EHD LOG NUMBER <br /> DEC. 3 0 2014 ENVIRONMENTAL HEALTH DEPARTMENT 16( 15 <br /> ENVIRONMENTAL HEAL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERNMEN <br /> ENVIRONMENTAL <br /> �lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> RVICES <br /> PUBLIC RECOUPS RPLEASE APPLICATION ``�� /l <br /> APPLICANT: USINESS/AGENCY: TE- <br /> ADDRESS: ( (� CITY/STA E/ZIP: Ind / ca ` F <br /> PHONE(1). PHONE(2): FACSIMILE: Z�� ' J� Sq `7 j <br /> Phase allow 10 business day`s from date of application submittal for the records to be available. / <br /> Staff will contact you to arrange Ian app tmen date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1 � S CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YS <br /> SIGNATURE OF APPLICANT � DATE ` <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE LY <br /> \ Street# Street Name City ` °M U 't 1 <br /> 1 3_7 tte/ d Lodl L <br /> 6 62— C �.i.� �Uni <br /> 3. 3 [, 1� W / 0 GCS �i Nom? I T,Np Cot" 5 <br /> 4 (,cam CUOl�o'F7 r41jA_A_4P wl( nit <br /> 6. 001 90M nit <br /> t <br /> r oj P cu (i le r/r S W- eacb ❑ Unit <br /> 9. <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From 3 to <br /> ENVIRONMENTAL-HEALTH DEPARTMENT FILES <br /> 1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ` UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> E�fABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ,HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ZOMPLAINTIRESPONSE RECORDS OTHE^"'LEASE SPECIFY) fl i <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8.00 AM-5:00PM(EXCLUDING HOLIDAY <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(209)464-0138 or mail to the address indicated above. Addressr t //V <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. I <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 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 /> 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 /> 3 711 2n .APw W is f <br /> ❑ Records provid d by Staff-PPR Cofnplete. Staff Name: <br /> EHD 48-06 //-�'� //�� 4/28/14 <br />