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RECEIVED <br />DATE RECEIVED EHD LOG NUMBER <br />DEC. 2014 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />E R4MENTALH L 1868 East Hazelton Avenue, Stockton, CA 95205-6232 , <br />PER ITENTALCES lephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />r~a PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: � I ' > a SINESS/AGENCY: <br />ADDRESS: Vv LL G CITY/STATE/ZIP: <br />PHONE (1), a of <br />PHONE (2): FACSIMILE: <br />Prase allow 10 business day§ from data of application submittal for the records to be available. <br />Staff will contact you to arrange an appa�tmenA date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUEST - $IAS E dASF,�,, <br />SIGNATURE OF APPLICANT <br />Electronic Information: ❑ List ❑ Map — Description: <br />CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS <br />f. DATE <br />FILE ADDRESS I EHD USLY <br />Specific Date Range of Information Requested: From i 13 to <br />ENVIRONMENL HEALTH DEPARTMENT FILES <br />:j'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br />2DTHECLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE - <br />R <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />'ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />rHAZARDOUSWASTEIHAZARDOUSMATERIALS ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES /��- `� <br />F1TATTOOIBODY PIERCING ZOMPLAINTIRESPONSE RECORDS OTHE^ "'LEASE SPECIFY) �"lr P! ?S <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 ryry__- . <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. AddressCWW_ <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 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 />:�i%liiR����.��i��;+�di�1Li►""�i`L'J�'Y•`iC rv� ' l�stJrifl�,/1�f1L�/1L/1J��'�d <br />•1.�Yl�i�►�IL+�j'�111��' 1`it*'.�'1ill��"/„ii.'[' a .�."Y " yfriiv.: Vii.:. :�! �' .��` �"++�-r..i'•t�`r�.�' :r���i�r'�rl � <br />-= �ii7f4'+Felrry��Ii37[':/'tiEii/_tLSwJ"7lfi:.,'• ' <br />■ Records i • • - • • ■ • CofnpletO. <br />EHD 48-06 / jjpp <br />I <br />4/28/14 <br />Street Name <br />MESON <br />1 <br />[[ <br />" <br />/ MOM � t <br />j <br />, <br />■ <br />irk <br />Specific Date Range of Information Requested: From i 13 to <br />ENVIRONMENL HEALTH DEPARTMENT FILES <br />:j'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br />2DTHECLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE - <br />R <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />'ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />rHAZARDOUSWASTEIHAZARDOUSMATERIALS ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES /��- `� <br />F1TATTOOIBODY PIERCING ZOMPLAINTIRESPONSE RECORDS OTHE^ "'LEASE SPECIFY) �"lr P! ?S <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 ryry__- . <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. AddressCWW_ <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 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 />:�i%liiR����.��i��;+�di�1Li►""�i`L'J�'Y•`iC rv� ' l�stJrifl�,/1�f1L�/1L/1J��'�d <br />•1.�Yl�i�►�IL+�j'�111��' 1`it*'.�'1ill��"/„ii.'[' a .�."Y " yfriiv.: Vii.:. :�! �' .��` �"++�-r..i'•t�`r�.�' :r���i�r'�rl � <br />-= �ii7f4'+Felrry��Ii37[':/'tiEii/_tLSwJ"7lfi:.,'• ' <br />■ Records i • • - • • ■ • CofnpletO. <br />EHD 48-06 / jjpp <br />I <br />4/28/14 <br />