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1'- 10/19/2015 19:24 209-796-4790 COPY CENTER PAGE 01/01 <br /> 2EI <br /> EIrZ <br /> DATE RECEIVED EHD LOO NUMBER <br /> SAN JOAQUIN COUNTY <br /> RECEIVE ENVIRONMENTAL HEALTH DEPARTMENT <br /> `) 1868 East Hazeiton Avenue, Stockton, CA 05205-6232 <br /> OCT 13 ZOIC Tel (200)465-3420 Floc: (209)464-0135 Web:www,Gjg0v.org1ehd <br /> ENMROI�Mk NTALHE(,ILTH PUBLIC RECORDS RELEASE APPLICATION <br /> koERMiT S P � �APPLICANT1 o'n O � BUSINESSIAGENCY- <br /> ADDRESS: <br /> 2 ' Pi �'�`�. �`� CITYM ATEMP: <br /> PI-oHE(i): PH-ONE(2): FACSIMILE: <br /> Please allow 0 business days From die of applicafftai submf: l for the records to be available. <br /> Staff vili contact you to arrange an appointment date and time to rev€ew the requested ox ds. <br /> ❑CHECK SOX TO EXPEDITE REQUEaT-$ISO FEE(CASE!OR CHECK ONLY)-REQUEST PROCESSED IN 3 SUSII4ESS DAYS <br /> cE RTE E@E Fel !e El4f ER'KIM' <br /> �- __ (`- <br /> oE�l e�raa w�.e ear aerrLee.Fan® e O F w ar p r� r s DATE /�l i I�? <br /> Electronic Information: ❑ List❑ flap-Description: <br /> FILE ADDRESS <br /> City <br /> 3 It Streat Nash EHC USE E1N[v <br /> I ko r n+on c4 . o Cj i �1�� I-1 �mt/�I e� <br /> 2. )3S® 1 N . -Thcr-r +oy- PcL <br /> iLoCLi n® F Qu�it� <br /> 1 ^3. _ �i i o C'KZb: t�`CS_ L C>ci 1 i{ ' NaP<G0 <br /> 4. kjlr <br /> S. i{ } Pr'0'r-y)+z)n R.,-4 Lo Gi. Ej,dnit a <br /> 7. Ih.,a-cyj+Oy R_,ar L 0 44--1 CUnit <br /> 8 <br /> SITE{MITIGA-1710N <br /> 9. { 1 N . 13_ Lo(:�J— <br /> ®. I 1 N. l ",'n�dYl ' Lo i v �c t;GC ®t� telt a <br /> Specific Cate Range of Info=xtfon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TASK(UST)CLEANUP Sri E(LOP) ❑WEDICAL WAS—it FACILITY Y ❑.SoUD WAm FACILI YrVEHICIE <br /> ❑OTHER CLEANUP SiTE(NON--LOP) ❑Housjw ABATEMENT ❑ihtASTE TIRE <br /> ❑UNDERMUND TANK(fk oNrrDRileDft woyAL) ❑Fo©D FACILITY �DARY <br /> ❑AaowaRouma TANK ❑CMCKEw RANCHf Doo KENNEL IAlAB't WATER TREATMENT PLANT <br /> I4AEARWUS WASTEMAZARDOUS MATERtkU ❑MOTELMOTEL ❑PuMPER TRUCKIYARD(CHEwcAL ToiLErs <br /> L u r-vzxra�A (_i FIND UsE APPLICATim StrEs <br /> ❑TATTO MODY PIE <br /> ❑COMPLAWIRFSPONSE Ri�OORbs ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PER&,tT F?ECotzos ARrAvATLA 3LE FoR REy Ew-. l?s°i6F DA-T-FRIDAY 8:00 Am-5:00r-+t(EXCLUDINC,H2 IDAYS) <br /> I. List-up to ton_addr+m"in the space above. Select the type(s)of files from the fist above by checking the appropriate <br /> box(es). At least one Elie type MUST be 6elected. Fax to(208? 1$Ler mail to the address Indlgated above Addrass <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <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 ttm applicant If any EHD flies exist. An appointment for review will be confirrned approximately ten(1 D) <br /> days after receipt of application. The file-s.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 sante condition as released Will be reorganized by EHO stairs at the expense of the applicant. <br /> Future file ravl by the same appilcant may require a$130 deposit prior to review. R0XFD -EHD USE ONL.e"- <br /> P �'W {► 17 <br /> ❑ Records provided by Staff-PPR Cornelate. sty Ne : <br /> END 4e <br /> Received Time Oct, 13. 2015 1 . 23PM No- 9777 <br />