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fF`,.m:Far8110n Consulting 4262960860 01/23/2016 08:31 #los P.001/001 PECEIVED DATE RECEIVED ED LOG 00NUMBE JAN 2 3 2015 SAN .10AQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ENVIRONMENTAL HEALTH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 PERMIT/SERVICES Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd RECORDS RELEASE APPLICATIO�Nn APPLICANT:_ scflr ALU � BUSINESS/AGENCY: EAUL(p,j ADDRESS: $'43-)- 0,00IF4 VALLC4 e.p, CITY/STATEIZIP: C.A PHONE PHONE(2): FACSIMILE: Please allow 10 business days from date of application submittal for the records to be available, Staff Will contact you to arrange an appointment date and time to review the requested records. !'CHECK BOX TO EXPEDITE REQU - 30 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BYySINESl!S DAYS SIGNATURE OF APPLICANT DATE I tLl f f (r Electronic Information: ❑List❑Map-Description: _ FILE ADDRESS END USE ONLY street# Street Name city _T . _. .. ................_n_�.___.._.___.._.-____....-_.__._..... O.Units 1. jZ t� M1tlAr\ f�l.J f{pvSp��tr 2. I Z�}'Z t S 3. 2 t `ll El 2 n .......-- ----- - . _ 4. �i Q$ ._-----------'----z 0 It 3 _ — - _ a S. z�txB3 tt�lZSa,y gA�t � - -:,- vhm B. Uttnit4 7. 2A1 .1-� - -- - -- - - --- - - IZ�tatt 9. --�-_—�------ ❑Unit fi Specific Dale Range of information Requested: From to 25 ENVIRONMENTAL HEALTH DEPARTMENT FILES i 25UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY p SOLID WASTE FACILITYfVEHICLE i ,WTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE 1 ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT ' �. HAZARDOUS WASTE/HAZARDOUSMATERlALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS ❑TIERED PERMITTED FACILITY p POOUSPA ❑LAND USE APPLICATION SITES ❑TATTOWBODY PIERCING ❑COMPLAINVRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) j WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS)* 1. List up to ten addresses in the space above. Select the p type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address indicated above. Address ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. i 2. For assistance in identifying the nature and content of END records,please contact END at the number noted above. 3. The END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten(10) ,days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. .Future rile reviews by the same applicant may require a$130 deposit prior to review. **'BOXED AREA-END USE ONLY*" I 4- - N n ct 7 1 es t ❑ Records provided by Staff-PPR Complete. Staff Name: EH1368-06 oarov+a g {I. Received Time Jan. 23. 2015 8:22AM No, 7946 i