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FIECt E® ! SAN JOAQUIN CQt9 1.NA&: SI06 '9 'AV anvil paAiaaaal <br /> APR 0 6 2015 cNVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 96205-6232 Q �� <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:vYww.sjgov.org/ehd o0 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES pp PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: o s tl;vja, 4 BUSINESS/AGENCY: <br /> ADDRESS: wv(c4,6 •Sk 5j Fz 90C) CITY/STATE/ZIP: Su . r✓w c, Sc� C I <br /> PHONE(1): (1 5- :.!f y-SSq Z,J 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 REOUAT.S1EE(WH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ilk. ter) ; DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street#G Street Name city <br /> J 1. � � 7 I �cICP_ ld✓� �-o���G� l�p'`/1� Unit 1 <br /> 2. / <br /> 3. 0 Unit 2 <br /> 4. <br /> 0 Unit 3 <br /> 7. (]Unit 4 <br /> 1814- <br /> 9 Unit e <br /> [aUnit S <br /> Specific Date Range of InfOrmadon Requested: From to .� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILETS <br /> �UNOERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACLITYIVEHICLE <br /> OTHER CLEANUP$ITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) [7 FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK QCHICKEN RANCHIDOG KENNEL . ❑WASTENATERTREATMENTPLANT <br /> U5 WASTEIHAZARDOUSMA7ERUiLS ❑MOTELIHOTEL9LCTHER(PLEA$ESPECn)UMPERTRUCKYARDICHEMICALTOILETS <br /> IERED PERMITTED FACILITY POOL <br /> 6 A AND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING �COMPLAINTIRESPONSE RECORDS <br /> WELLANDSEPTICPERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAYS:OOAM-S:OOPM(EXCLUDINGHOLIDAYS) <br /> 1. Llst un to tan addresses In the space above. Select the type($)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 bo 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 EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 1110 reviews by the same applicant may require a$130 deposit prior to review. "AQXED AREA-EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete. staff Name: ti <br /> EHD 4&e0 0e1114 <br /> S0/T0 3900 9NIlO115N00 AdQ L70956D5S4 9Z:SL 570Z/90/D0 - <br />