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rram:Terracon 916 B58 8277 OB/26/2013 11 :19 #093 P.001/061 <br /> PEPE GRENEU END LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> AUG 2 6 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 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 /> I� PERMITIsERVICEs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> 4 ADDRESS: of --,4 /70 CITYISTATEIZIP: +, 1,.0 Dor c-� gf-na <br /> PHONE(1): Q1L PHONE (2): FACSIMILE:C,V& Asw— b <br /> TENTATIVE*APPOINTMENT DATE: <br /> Time: <br /> (Please allow 10 business days from date of application submittat.-'Tentative only-must be confirmed) <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 /> 4D <br /> FILE ADDRESS EHD USE ONLY <br /> �JU Street# Street Name City 0 Unit 1 <br /> 2. Unit 2 <br /> 3. <br /> / 4' 7/`/ � C% &-W9 La,-e- .1 et�� fell 3 unit3 �y <br /> bo[ &�;,Ja .IBJ unit 4 <br /> 7. 3 y�� l-f 1 � � iq <br /> El Uni <br /> b _ <br /> �k 10. I] Unit 6 <br /> -Q Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -p�UNDERGRouND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACT IV <br /> OTHER CLEANUP SITE(NON-LOP). ❑HOUSING ABATEMENT ❑WASTE TIRE 12 � }e- <br /> i <br /> IRUNDERGROUND TANK(MONITORINGIREMOVAL)V4-- ❑FOOD FACILITY ❑DAIRY 9�1��I3 <br /> ABOVEGROUND TANK C ❑CHICKEN RANCH_1 DOG KENNEL ❑WASTEWATER TREATMENT PLANT, <br /> HAZARDOUS WASTENAZARDOUS MATERlALSQZ- ❑MOTELMOTEL' ❑PUMPER TRUCKIYARDICHEMICALTOILETs <br /> TIERED PERMITTED FACILrrY ❑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-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List unto 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(208)464-0138 or mail to the address iltdicated 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 /> s <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) i <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, 'BOXED AREA-EHD USE ONLY' <br /> f.0WA 0 'z � <br /> : : . . �� 40 14A Q <br /> b <br /> O-Reoordg'pr,w ided•byt Sta.�RP_R-Complete staff a�,r3: _ <br /> 91 W11 <br /> Received Time Aug. 25. 2013 11 : 13AM No. 3923 <br />