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■ 01/01/2010 00: 08 20933983"- MIDCAL INDUSTRI(* PAGE 01/01 <br /> t■ <br /> � <br /> E aRrrr�t�1SAN JOAQUIN COUNTY <br /> X� ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 2 1 2Q1rt. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> telephone: (209) 466-3420 Fax: (209)464-0138 Web: www.sigolu.org/ehd <br /> ENVIRONMENTALHEALTi-I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: / b YU BUSINESS/AGENCY/,E1fO <br /> ADDRESS: tL191 D 741*;1;r/ /'kyYt! G'-X71 CITY/STATE/ZIP: sroe,1-rs� Cf q�a� <br /> PHONE (1): 941­461a6d T PHONE (2): FACSIMILE: <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 appointme date and time to review the requested records. <br /> ❑ CHECK BOXTO EXPEDITE REQUEST-$130 FEE(CAS OR HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I/- Z i - / <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. L ❑Unit 2 <br /> 3. <br /> 4. <br /> L�f Unit 3 <br /> 5. O <br /> 6' Unit <br /> 7. <br /> B. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit6 <br /> Specific Data Range of Information Requasted: Fromy to 1 <br /> ENVIRONMENTAL HEAL H DEPARTMENT FILES c;U <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE /,?� <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE �.�le <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ED FOOD FACILITY ❑DAIRY UI�VL'I� <br /> OVEGROUND TANK CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT I Z <br /> 5RfiAZARDOUS L] [I WASTEYHAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE 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. Fax to (209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 files 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 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$130 deposit prior to review. —BOXED AREA-EHD USE ONLY"' <br /> &VCull u) aL57- PileC <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4B•o8 <br /> 08101 M4 <br /> Received Time Nov. 21. 2014 9:30AM No. 7605 <br />