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02/20/2014 12:17 5106559E= ENVIRON PAGE 01/01 <br /> D/,t7�R aQCFELVF �� EHD LOG NUMBER <br /> ,(,.J� SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 2 0 201 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: WWw.sjgov.org/ehd <br /> ENVIRONIT/SER_HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SERVEC�S <br /> APPLICANT: }&( P, LOM.W BUSINESS/AGENCY: l=s1ViP-ON <br /> ADDRESS: QxW RY 01 G+. , Suzk q00 CITY/STATEIZIP: "t Its I"A <br /> PHONE(1): q/O-V10— 2S(P9 PHONE(2): loSl - 30B—I3ra4 FACSIMILE: 5IO—(oSs—!st-- <br /> TENTATIVE*APPOINTMENT DATE: /v)aVG11 lot aot�f Time: 47 :iOD AM <br /> (Please allow 10 business days from date of applilfo submittal-•Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU T-$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 /> Street 8 Street Name city ❑Unit 1 <br /> 1- 1 9;L 0 Haklaki Po614 La-thLAD M t�M1+1 NecO�(� <br /> 2. ❑Unit 2 <br /> 3. <br /> f <br /> 4. ❑Unit 3 <br /> 6. -ten.�i '15nit4 <br /> 7. <br /> 8. ❑Units <br /> 9. <br /> 10. ❑units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE I e11� <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE ` <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY tllJ-�.l'1 <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT 3 <br /> HAZARDOUS WASTEIHAZARDOUS MATERALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USEAPPLICATION SITES <br /> ❑TATTOo1BODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 appointmentfor 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. Afile 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 atthe expense of the applicant. <br /> Future file re' grsxwmU_ .L.I <br /> - 3-3A ?r'i✓ikj - <br /> =D A 0*101n Vleti L:d- b°' Chnis),0 LLC- S / - <br /> _ — ��s4ri Ioc Lf Ton C¢sl it , 'P'Z'V IdZd app 1/Canf- C6PLI . <br /> of business o� ,�e� /op°` t'r- I d cervi Vte� - <br /> Received Tlme 131�� 9/4112 <br /> Lisp gain Pile rYta-ILp.( <br />