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"""� ! EHD LOG NUMBER,.., <br />1.. I r 'i7 <br />SAN JOAQUIN COUN , s <br />ENVIRONMENTAL HEALTH D� <br />FEB 20 2013 1868 East Hazelton Avenue, Stockton, CA 9520 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />ENIVF vNMEINVI&'HiEN-7"-: <br />CIs=^rO—roERI ;: PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSINESS/AGENCY: <br />ADDRESS: �� iRA�'�ING /,JAY CITY/STATE/ZIP: j_To C.jz�70� ._ CA <br />PHONE (1): qo $ - yam( t%— 600 - PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />BOX TO EXPEDITE REQUEST—V25 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIACUIECK <br />TRE OF APPLICANT ,-� DATE ,P, , <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street # <br />Street Name <br />City <br />❑ Unit 2 <br />2.. <br />3. <br />Unit 3 <br />4. <br />5. <br />6. <br />� <br />Unit 4 <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From '-_� a / 0 7,55;R I-� to '/) A a <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) El SOLID WASTE FACILITYNEHICLE% <br />( ) ❑ HOUSING ABATEMENT ❑ WASTE TIRE -, d r/r� 1 4 <br />UNDERGROUND TANK (MONITORINGIREMOVAL�-_. ❑ FOOD FACILITY / �i (� <br />ABOVEGROUND TANK __ DAIRY � iG9� �- �. J -I �' . <br />❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS 7 ❑ MOTELIHOTEL <br />: T ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED PERMITTED FACILITY <br />❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />TATTOOIBODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (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 appropriate <br />box(es). At least one file type MUST be selected. Fax to (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 received 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 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 />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application 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 same applicant may require a $125 deposit prior to review. **'BOXED AREA - EHD USE ONLY*** <br />n+ U�� i V, { �. /I , l �/�} 7 i i <br />If � <br />Fbi;iecord�s�rrorrided­brStaff-P-P RConpa€te. sA-ffta,e: <br />CUM — — <br />914112 <br />