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DATE RECEIVED EHD LOG NUMBER <br /> e 1'r z- - SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR 0 209 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> elephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> .cam;€seg- <br /> APPLICANT: //Aj /'-f � BUSINESSIAGENCY: <br /> ADDRESS: CITY/STATE/Z(P:�/� <br /> PHONE(1): ;6)6IIV-l?SY/ PHONE o_49-4 FACSIMILE:) 28c' <br /> TEN TAT/VE'APP01NTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal--Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- 12 FFE CASH OR C CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT y �� �4!J DATE 8 /3 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city Unit 1 <br /> J 2. <br /> Unit <br /> V' 4 �']Unit3 <br /> ,p Unit4 <br /> 8, <br /> unit S <br /> 9. <br /> 10. __ <br /> D Unit 6 <br /> Spocific Data Range of Information Requested: From /qqp to �,p, sJliT Z11 <br /> ENVIRONMEI�NTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) W MEDICAL WASTE FACILITY ❑SOLID WASTE FACE.ITYIVEHICLE �'^ <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE q h-�ule�%s kl' W' 11.5 <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) El FOOD FACILITY ❑DAIRY Y' LI-1�,; <br /> ABOVEGROUND TANG( <br /> ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS M` ❑MOTELIHOTEL ❑PUMPER TRUCKIYARO/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑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-S: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)464-0139 or mall 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 now 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. �-86XE0AREA-EHD-USE ONLY <br /> ❑ Records,provided, Staff-QPR'Cohtplete.staff Natiis: . <br /> EHD Ia-0a <br /> 94111 <br /> Received Time Apr. 8. 2013 1 : 05PM No. 2775 <br />