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07/09/2018 09:26 9166486688 ADR PAGE 01/01 <br />7■ <br />#EMVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT 16 Ct 133 <br />JUL 0 9 2018 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 /1id <br />PERMIT/SERV CES l"' <br />r � <br />U <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Cj��'/T3�'/G BUSINESS/AGENCY: �l ���� Ey�^IUv�w�c�Ilfl CIwG��7 <br />ADDRESS: �Z (J S CITY/STATE/ZiP: <br />PHONE (1): 71 _qq F67600 PHONE (2). '71L - e2(, S/7 FACSIMILE: <br />TENTATIVt=*APPOINTMENT DATE: jyllV Time: ICI �►�, <br />(Please allow 10 burlheea days from date of opplleaflon submittal - "Tenlative only - murk bo confirmed) <br />[]CHECK BOX 70 EXPEDITE REQUEST - 125 FEE (CASH OR CHECK ONLY) - REQUEST PROCE=SSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT Sr��/ DATE 7/ 9/7�l�' 7( �7 <br />Electronlc Information: ❑ List ❑ Map— Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />3 it Y er <br />F2, <br />Street !/ <br />Street Namo <br />CRY <br />Sf- G C� � GC�1 <br />Sh cls 1� <br />(.,j <br />El <br />[Sj� <br />14I. -I iAV <br />4. <br />5. <br />&, <br />S. <br />®� <br />10. <br />Spoclflr. Date Range of Informallon Requested. From 1411 to <br />,�{ ENVIRONMENTAL HEALTH DEPARTMENT PILES <br />LJ UNDI]RGROUND TANK (UST) CLP.ANUP SITE (LOP) ❑ HOUSINO ABATENJENT ❑`SOLID WASTE FACILiTYiVEHICLE <br />110THER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOvAL) ❑ Doe KENNEL ❑ DAiRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT <br />TIERFO PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEMICALTOILETS <br />❑ TATTOOIEODYPIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ MEOiCAL WASTE FACILITY ® COMPLAINT RECORDS ❑ OTHER (PLEASE SPECifY) <br />WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 9:00 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 fife type MUST be selected. FaX to(200 464 04 -6 or mail to the address indicated above. Address <br />ranges will not be accepted - for additional asalstance 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 5140 files exist. An appointment for review will be confinned approXlnjately tan (10) <br />days after receipt of appilcation. The flies will be held for a maximum offive 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 Immedlately 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 expanse of the applicant. <br />Future file reviews by the samo applicant may require a $125 deposit prior to review. <br />iy� <br />E a-06 .....,w 811 n 1 <br />Received Time Jul. 9, 2018 8:43AM No,3832 <br />