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EMIR 04/04/2016 MON 12.-49 FAX 0001/001 <br />E IR <br />E12 <br />IEE D EIV_ ED I;HD LOG NUMBER <br />_ SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT - <br />1888 East Hazelton Avenue, Stockton, CA 95205-62327 <br />APR 0 4 46phone: (209) 466-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTAL H TH 4; <br />PERMIT EF •-"'PUBLIC RECORD'S RELEASE APPLICATION <br />APPLICANT: Lyla Gray-Etherson DUSINESS/AGENCY: Property Solutions Inc <br />ADDRESS: 323 New Albanv (toad <br />CITY/STATEIZIP: Moorestown, N108052 <br />PRONE (1): 856-813-3000 ext245 PHONE (2): FACSIMILE: 856-813-1073 <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - "Tentetivo only - muet be confirmed) <br />❑ CHECK BOX TO EkPEDITEREQUES $1Z5 FF (CA OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �� DATE <br />Electronic information: ❑ List ❑Pap — escriptlan: <br />FILE ADDRESS <br />FHP USE ONLY <br />(A viol Ifol, a0 �t - 0 U'nit, <br />_ <br />Street # <br />_ <br />Street Name <br />city <br />f41- <br />I S- <br />St j c LA �� <br />57c�«� E� .-� <br />�poq. ,r� <br />/&0 'Unit z <br />2. <br />.�(2 <br />❑ CHICKEN RANCH <br />5 <br />F-1TIEREDPERMITTED FACILITY <br />❑ MOTEUHOTEL <br />❑ PUMPER TRUCKNARD/CHEMICAL TOILETS <br />❑ TATTOOIBODY PIERCING <br />nit 3 <br />4. <br />❑ MEDICAL WASTE FACILITY <br />❑ COMPLAINT RECORDS <br />❑ OTHER (PLEASE SPECIFY) <br />Sa <br />7. <br />unit S <br />�'ji' <br />/tfrrtt-#6 <br />9. <br />10. <br />Spaclfic Data Rang® of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (USI) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ WASTE TIRE <br />® UNDERGROUND TANK (MONITOR(NG/REMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />❑X HAZARDOUS WASTE GENERATOR/ft"✓ , (�jg( - <br />❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />F-1TIEREDPERMITTED FACILITY <br />❑ MOTEUHOTEL <br />❑ PUMPER TRUCKNARD/CHEMICAL TOILETS <br />❑ TATTOOIBODY PIERCING <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ COMPLAINT RECORDS <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILAaLE FOR REVIEW: MONDAY -FRIDAY 8:00 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 file type MUST be selected. Fag to (2Q9] 464.0138 or mail to the addreas Indicated 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 />2. 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 />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 p�yjnesy "ulre a $125 deposit prior to review. <br />Received Time Apr. 4. 2016 10:48AM No.0655 1. <br />,i 6YI <br />