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11/18/2014 10:56 9164644 SWRCB • PAGE 01/01 <br /> DATER a <br /> I R � ` SAN JOAQUIN COUNTY EHD LO(+NUMBER <br /> _'J14 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 qp;;L <br /> I IRI Mgta(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> E�iV1oR�N�Eect.�n[;ES <br /> 07 <br /> PUBLIC RECORDS RELEASE APPLICATION6:M' •49wc <br /> APPLICANT: nn BUSINESS/AGENCY:C �, q <br /> ADDRESS: 1/azo Prt >i �5 ,�� CITY/STATE/ZIP: 01 h' <br /> (1 <br /> PHONE(1): 9�1r /�} lS PHONE(2):/ L - FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: s Time:�.�— <br /> (Please allow 10 business days from date of appllc n submmet-'Teniafrve only-must no confirmed) <br /> ❑CHECK BOX.TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: 6a rN r S <br /> FILE ADDRESS EHD USE ONLY <br /> Streets Street Name city 0 Unit <br /> 20 u e C11L / <br /> 5F <br /> 1`Ai 0Unit lv� <br /> 3. /Ll1 <br /> 4. t(�w/ _❑Unk3 <br /> 5. <br /> Unh4 <br /> 8. 0 Unit 5 <br /> 9. <br /> 10. Unit <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 9ICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILrIY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONRORNG/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HA2ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERW"ED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHE'dICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SI'ES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:60PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the apprt priate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to tbq address indicated above Address <br /> ranges will not be accepted-for additional assistance with Nle addresses,contact the EHD. Applications receiv ed 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 conNrmed approximat sly ten(10) <br /> days after receipt of application. The Nles will be held for a maximum of five business days for review. Appoint)rents <br /> should be scheduled accordingly. <br /> 3. A 1`11e that is actively being worked on by EHD staff may not be Immediately available for review. A new appl(cati on may be <br /> submitted when the file is available_ <br /> 4. Any Nle not returned in the same condition as released will be reorganized by EHD staff atthe expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EHD USE ONLY <br /> eWn.0-na NMI <br /> Received Time Nov. 18. 2014 9:47AM No, 7572 <br />