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11/18/2014 10:56 9164644 SWRCB • PAGE 01/01 <br /> DATER <br /> � �\j E . . SAN JOAQUIN COUNTY EHD LO0 NUMBER <br /> 1vIJV g 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Iq <br /> Ec <br /> jy1.� i @N(209)468-3420 Fax: (209)464-0138 Web: www,sigov.org/ehd <br /> F_NVI�RbN� rF�rtrES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY:- <br /> ADDRESS: <br /> .1167zo <br /> USINESSIAGENCY:ADDRESS: .LIOzo &'tnP� l r 2Ojp� CITYISTATEIZIP' rrj <br /> PHONE(1): 9�6r��o� �plS PHONE(2):/��.� FACSIMILE: <br /> rr�. <br /> TENTATIVE'APPOINTMENT DATE:e2� Time:� <br /> (Please allow 10 business days from data of applicatibn submkin I-•Tentative only-must be confirmed) <br /> ❑CHECK BOX.TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONL`f)-REQUEST PROCESSED IN 3 BUSINESS D\YS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map—Description: 1157 6e�i1t r'1 S <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city Unit 1 <br /> 1. e u e c9 t <br /> 2• 22 221r 1 3(!�Iq <br /> 3 Unit2 <br /> 4. t11w <br /> ,_❑U nk 3 <br /> 5. <br /> unit a <br /> 7. <br /> 171 8. <br /> units <br /> 9. <br /> 10. <br /> Unit 8 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEI IICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCKIYARDICHELAICALToa.ETS <br /> ❑TATT00IBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SI'ES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8;00 AM-5:OOPM(EXCLUDING I iOLIDAYS) <br /> 1. List-up to tan addresses in the space above. Select the type(s)of files from the list above by checking the apprc priate <br /> box(es). At least one file type MUST be selected. Eex So(209)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 receiv°d 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 approximat sly ten(10) <br /> days after receipt of application. The Nies will behold 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 appiicab on 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 some applicant may require a$125 deposit prior to review. <br /> EHO USE ONLY <br /> FNA AAlIR !11111 <br /> Received Time Nov. 18. 2014 9:47AM No, 1572 <br />