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"21=14.;tIVE® <br /> DATE RECEIVED EHD LOG NUMBER <br /> DEC. 3 0 2014 SAN JOAQUIN COUNTY .%d <br /> ENVIRONMENTAL HEALTH DEPARTMENT ok\ <br /> ENVIRONMENTAL HEAL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVICES lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd' <br /> 1 PUBLIC RECO,RPS RPLEASE APPLICATION <br /> APPLICANT: rr1 6 SINESSIAGENCY: 7� J <br /> ADDRESS: - l CITY/STA EIZIP: 6 C� <br /> PH0NE(1)��t— «?jpHONE(2): ]3coj FACSIMILE: ZOg ' 3zj �—yW 7 <br /> Phase allow 10 busidess day§from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an ap ointmen date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$733 CAS CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YS <br /> SIGNATURE OF APPLICANT DATE ` <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE LY <br /> Street# Street Name city M <br /> 3 W iL�/ u z1 <br /> le��♦j ( � <br /> 6Z �rt-c ti OUJli� 3p Unl <br /> 4 Z3wo09733�3 (LI-57 nit 3 <br /> 5 1 n4 Lb M �J p tt3u7 Z� <br /> It. 6) 1 D 01 ,6 0 0 Al 11 <br /> $ -16 5 • 1 IP 5 rea(. l f Unit <br /> 9• s Z <br /> 10. <br /> ❑ Unit s <br /> Specific Date Range of Information Requested: From3 to <br /> ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILDYNEHICLE <br /> THEIR CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT El WASTE TIRE - <br /> UNDERGROUND TANK(MONnORINGIREMOVAL) ❑FOOD FACILITY [_1 DAIRY <br /> 2-AI30VEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUSMATERlALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING jXcOMPLAINT/RESPONSE RECORDS 1rOTHE-'"LEASE SPECIFY) >�r <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00/A`M-5:OOPM(EXCLUDING HOLIDAY <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 jS/ �, <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address indicated above. Addres <br /> ranges will not be accepted.Applications received after 3:00 pm wi11 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. i <br /> 3. 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 tiles 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 13 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 /> / — {/) <br /> -15I mPFoy4,(43 -7 21 Ale wWLs z , <br /> ❑ Records provid d by Staff-PPR Cofiriplete.Staff Name: <br /> EHD 48-06 <br />