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E 05/12/2015 10:59 209833070 UPS STORE1860 • PAGE 01/01 <br /> 0 ED REGEV <br /> EHD.LOG NUMBER <br /> % SAN JOAQUIN COUNTY , <br /> MAY 12 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> U <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL HEADIlephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd <br /> PERMITISI=RUiCFS <br /> PUBLIC RECORDS RELEASE APPLICATION LI (, <br /> APPLICANT: ,Sen BUSINESSIAGENCY: Gf'6� ( ea <br /> ADDRESS: CITYISTATE2IP: I�cy1(�e/�J12 P <br /> PHONE (1): 3 I-76Z- PHONE(2): FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records, <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: <br /> FILE ADDRESS_ EHD USE ONLY <br /> -1Street @ Street Name City ❑Unit 1 <br /> 2. 4{fSC� W. S�Y 2 _ (- l ❑U_nil2 <br /> 3. 4Cgr_ J <br /> 4 (J Unit 3 <br /> 6. unit 4 <br /> 7. 1'(9vl�el �fIfCS M� (tq°�5 <br /> ❑unit 5 <br /> s. <br /> 10. 1 ❑Unit a <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY [:1 SOLID WASTE FACILITYIVEHICLE <br /> c�T ER CLEANUP SITE(NON-LOP) Fl HOUSING ABATEMENT ❑WASTE TIRE <br /> [uL]'QNDERGROUND TANK(MONITORDWREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> [DIKBOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 2-ifgARDOUS WASTEIHALIRDOUS MATERIALS ❑MDTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> MfIEREO PERMITTED FACILITY ❑POOLISPA ❑LAND USEAPPLICATION SITES <br /> ❑TATTOO/BODY 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(2091464-0138 or mail to the address indicated above. Address <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 END 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 /> rov'K1e) legh OF- V- "t it IN' k (70 9 "I (Q 33v7s7- are 'n e <br /> US rue vpf I i4o I <br /> El Records provided by Staff-PPR Complete. staff Name: <br /> 4rzena <br /> Received Time May. 12. 2015 10:54AM No. 8709 <br />