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I FIVED SAN NTY O' <br />JUL 1-7 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ENVIRONMENTAL HI1, fp8hone: (209) 468-3420 Fax: (209) 454-0138 Web: www.sjgov.org/ehd <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />L <br />0 <br />APPLICANT: ori t� C+�I �� 5 .�' - BUSiNESS/AGENCY <br />ADDRESS: ��i'1 T�t�{.F�- �,jUt• 1�, SO�� CITY/STATE/ZIP <br />e� re� - -- -- — <br />PHONE (1): r'j s = 5 U I PHONE (2): ) 5'41. a) -a, =r-) C,`_ FACSIMILE: (-1 1 S .'%f•V. '-1 `1 L,;.*Y <br />I <br />Please allow 10 business days from date of application submittal for the records to be available. <br />s Staff will contact you to arrange an appointment date and time to review the requested records. <br />>f�j CHECK BOX TO EXPEDITE REQUEST: x$1.25 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN,a-DUSIN`ESS /)DAYS <br />vII"`AI `A,TvIPE vC rA-.DDLIf.. r�. A�7�i -D -T-E <br />1 <br />IElectronic Information: ❑ List ❑ Map — Description: <br />Street # <br />FILE ADDRESS <br />Street Name <br />city <br />cv EHD USE ONLY <br />t__o <br />2. <br />3. <br />'1 C.y t t <br />S .r :✓ <br />crkd , ,. <br />ST N M <br />CdS,� <br />M❑Unit <br />3 <br />5. <br />�} <br />�'-� ✓ �;�- uli- <br />�}v C W z: /� <br />,9` <br />N;aPa un�(� <br />' <br />❑.Unit4 <br />6• <br />aq, a La , 1. f�) ")- �, �E't� 35 r <br />❑ Unit 5 <br />8 0/ A� <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Q UNQERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYNEHICLE 14 014�7 <br />THEIR CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE (A <br />W DERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />❑ HAZARDOUS WASTEIHAZARDOUSMATERIALS ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ P OL/SPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑i COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (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 $125 deposit prior to review. ***BOXED AREA- EHD USE ONLY*** <br />ks�i —61 4 - 7.cv,p silm5rn ` t.vviCU,,1 CO of: 2M 5ijm5on •tA5-r io,:9 W', 5000 <br />4 PI?o5o3yg7, & 7ion Atr po-d- -us-r inonti. pf_oz3)WI Sicnkd a <br />iKli LtarlfwAr.k► :n •IJle dlr1 nNo�rL .cam <br />v ICU <br />r,* -i• <br />Irpol. <br />Airpot#- - LAST p�.6zavooy <br />son <br />