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a"on tq,on=ulTing . 4252950850 02,' 11"157 <br /> RECEIVED SAN JOAQUIN COUNTY <br /> FEB O 2 2015 ENVIRONMENTAL HEALTH DEPARTMENT go <br /> C/51868 East HazeRon Avenue, Stockton, CA 952056232Telephone: (209)468-3420 Fax: (209)46138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTALHEAL4-0 <br /> TH <br /> PERM0ERVICE2 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: J� Lnt, au.t rJ BUSINESS/AGENCY: 3 A9A,L,I,p,j <br /> ADDRESS: �'yJZ k. <br /> � � � bDl;� (fr�t.t,t,'�•1 Lt CITY/STATFJZIP:�/� p,Q�,( Cq SX.t�Z4' <br /> PHONE(1): �T � tl L 1 •-.IY i 11'� PHONE(2): FACSIMILE: r <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 REOUE 130 FEE(CASH OR CHECK ONLY),REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE fy <br /> Electronic Information: ❑Lfat❑ Map—Description: <br /> FILE ADDRESSEHOUSEONLY <br /> street M street Noma _�____. any <br /> Unit 7 <br /> i. <br /> 3-�--- — — --------- Uniii. <br /> 4. Unit 3 <br /> /(f <br /> 6. �-• 1 ,_ rtfVlaeK� X15, <br /> p u tr u ft4 <br /> 7. <br /> -- <br /> 10• I <br /> Unit 6 <br /> Specific Date Range of iMormallan Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILES <br /> IMI NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FActmYNEHKIE <br /> C�OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> LDf UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> AaOVEGAtYJM7 TANK ❑CHICKEN RANCW DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUC NARDICHEMICAL TOILETS <br /> ❑TIMED PERMITTED FACILITY ❑PDOUSPA 1 .,T <br /> STES <br /> ❑TAnoo/BoDY PIERCING ❑OTHER <br /> USE EASEAPPLSPECIFY) <br /> PE IF ) <br /> ❑COrtPU.WIfRESPONSE RECORDS ❑OTHER(PLEASE SPEtlFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:'DO AM-6:00PM(ExcWOtNG HOLIDAYS) <br /> 1. Llai ua to ten addresses In Me space above. Select the type(e)of files from the list above by checking the appropriate <br /> box(es). At least one Fib typeMUST be selected. Fee 10 12091464-0139 or mail to file address indicated sbOve, Address <br /> ranges will not be accepted.Applicalions received after 3.00 pm w1R be processed the next business day. <br /> 2. For assista nce in identifying the nature and content of EHD records,please correct EHD at the number noted above, <br /> 3. The END will notify the applicant If any EHD roles exist. An appointment for review will be corlf rnned 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 Sartre corWitiun as released will be reorganized by EHD staff at the expeosa of the applicant <br /> Future file reviews by the same applicant may require a 3130 deposit.prior to review. ^`t30XED AREA-EHD c nNI Y•H <br /> IJ <br /> M. <br /> y <br /> K T-kP, <br /> ❑Records provided y Staff-P R Complete, si,H Name: <br /> sxo aaas <br /> oenvu <br />