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From.Terracon 916 858 B277 06/26/2013 11:19 #093 P.001/001 <br />I■ <br />■ <br />1 <br />$RECREW E® EHD LOG NUMBER SAN .10AQUIN COUNTY <br />AUG 2 6 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 qA <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: dRk�BUSINESS/AGENCY: `T�ir�ecF.- <br />ADDRESS: 3 /,gam /o( ?2� e 'D,_ --,,( /'7b CITY/STATE/ZIP: <br />Cw t-aT OvQ _ <br />PHONE (1): 6ft> 8S'8--15) 9 PHONE (2): FACSIMILE:A/G) 05'13- 647 ) <br />TENTATIVE` APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE <br />Electronic Information: ❑ List ❑ Map — Description: <br />•c 11 ul-. calf <br />FILE ADDRESS <br />EHD USE ONLY <br />'11Unit 1 <br />Street # <br />Street Name <br />���1 <br />City <br />1. <br />7 a(or <br />%+-•.y�� [ 4.�.a <br />fa.� <br />1/N M %1 r�.�olfi7 <br />ke `�.�' li i Unit2 <br />2. <br />4702-r!�g..►...6i <br />LcrNr 'n <br />�E.lo� <br />3. <br />j 5 L019, <br />0(UlL 5 � D'unit3 <br />4. <br />%/t% <br />Lore <br />5. <br />j % m $ <br />'/aw.ec,� <br />>L Aki, rlolo 0.. 1-4,- e- <br />.4ocO-P <br />(j'z' d !VJ co' W- �/ <br />.^iu (()r✓l7 -E Unit4 <br />Ai0 L&t f f O Un <br />6. <br />B. <br />36[15 <br />3 y�� <br />(�q�•r.�•er Lo..� f <br />/C�Q/"t--+ i Low - <br />J�o ��QJQP <br />9. <br />10. <br />77 a <br />//na.� <br />��o� <br />/y1 , /Q 71, N:) tuY /f" <br />Q Unit e <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />'-UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACIUJYIVVEHIC i <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE I _Z <br />UNDERGROUND TANK (MON ITORINGIREMOVAL),`' ❑ FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTE/HA7ARDOUS MATERIALS,.-" ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEMICAL TOILETS <br />TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:0OPM (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. Fax to (209) 464-0138 or mail to the address 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 confinned approximately ten (10) <br />days after receipt of application. The files 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 same applicant may require a $125 deposit prior to review. —BOXED AREA - EHD USE ONLY— <br />ri <br />•c 11 ul-. calf <br />_�}_ <br />t% w I _ i i i►c 1 J , <br />• • • • • • • •• MMMM, gillg ', <br />cnu co-uo8�4�12 <br />- <br />-, � O (.0m �, i on : �,Q <br />Received Time Aug, 26, 2013 11:13AM No.3923 <br />