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' 28 -2013 11:36AM Enviro Assess 8776235493 page 1 <br /> • <br /> ■ <br /> EHD LOG NUMBER � <br /> Ir ° UCIVE�AIE SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT f <br /> OCT 2 S 2pi8 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> telephone: (209) 468-3420 Fax: (209)464-0138 Web.www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICE <br /> �S <br /> / /P/U1BLIC�/RECORDS RELEASE APPLICATION n <br /> APPLICANT: /V /�f("f �(l BUSINESSIAGENCY: !V✓/RD <br /> ADDRESS: �• ©. 8OX �� CITYISTATEIZIP: &74e rS <br /> PHONE(1): Z07- 2G4- 05_0'/ PHONE(2): R-7%:7- 49 29—6938 FACSIMILE: 97J- 023 55 9`3 <br /> TENTATIVE'APPOINTMENT DATE: PLS. Cf}LL it rECM6 roulefime: <br /> (Please allow 10 business days from date of application submittal-`Tentative only.must be confirmed) <br /> ❑ CHECK BOXTO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE &f AS- A00 <br /> Electronic Information: ❑ List ❑ Map-Description: tC <br /> FILE ADDRESS END USE ONLY <br /> ^I <br /> Street Street Name City II <br /> El � <br /> Mp <br /> ❑ Unit 2 <br /> 3. <br /> 4, /❑Unit a J <br /> 6. i Unit 4 <br /> i <br /> 7. <br /> $, ❑Units <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> p� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> p1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE Ly{Ilt�� <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑PODUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ®COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:00 AMS: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 confined 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. - <br /> il- 7 IBJ cCrvTplcw <br /> ET(e- T' prL)` 0—Qu a IlcartTroeD cf W''4 .; . <br /> 3 y.. k �(--7-1�j 60�(,)�iT'f" (Rmi t7j-7z� iY'S106) <br /> ✓1jYAU c , :n U-5Y41.2 IP• Ir's x rr . <br /> 9/N12 <br /> EHU IB-OB <br /> Received Time Oct. 28. 2013 12:48PM No. 4368 <br />