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QA �R <br /> i _ SAN r NT` -- <br /> JUL 7 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> NVI i I iENTAL t Wf Rhone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> PERMITISERVICE <br /> PUBLIC P CIOPDS RELEASE APPLICATION <br /> APPLiCANT: ' 'C. 1_*:-t.as i ' ` T BUSiNESSIAGENCY: s '� <br /> ADDRESS: t `I t I .� -;. 1,Itc r t t k� CITY/STATE/ZIP: W f. i(A- Its t l I Sri <br /> j PHONE(1): ' ? {; PHONE(2): S S-4, Lb-a, 14-1 C-`T FACSIMILE: _'el t$ -.74u. <br /> I I ` <br /> Please allow 10 business days from date of application submittal for the records to ti`h' <br /> 1 Staff will contact you to arrange an appointment date and time to review the request d _ r4§' <br /> . <br /> t,j .r1� Q CHECK BOX TO EXPEDITE REQUEST:7-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN,aBUSINE <br /> �..--., CIP_`0.I R'PItDC.`uC nDDa_i�eR A$ �.� L....— -»Fi-� •E ! � � { � i ' I <br /> � sti <br /> Electronic Information: ❑ List❑ Map—Description: - : ti f , `�r a t't ;old ) <br /> , �f <br /> FILE ADDRESS ; EHD USE ONLY <br /> Street## Street Name #3rUv ' City ,, i� "�r• .,s }1 5 � <br /> _570; t,l •..� . M�t--Lt t-(r7 is :tr•.i" f,�.rrft : ca :5 l l3�.t:s�...`���t � � �s t,®" <br /> 2, ( 4 }, <br /> 1 K` �.-c1 t,�=�°-��-��' �a..r f=� �-��rr ..f��:--'��•.�, a s i�,is ��`� �'� ;,� ��.1 r����.-�., �' l <br /> 3, <br /> 4. 1 J -'**• ,T1 r .�r� t C `"l ti '1 [r Unit 3 <br /> /6. ifs ate° ❑Unit 4 <br /> 7. <br /> fJ',`w..,,,,, J `�:-^..'; l'"....T.C.'1.t« t r...;,,�{ ;::.,j }i � }._..J'-"i J 4t } .,.�•-_-'�i Gt 8 ff 76( <br /> ❑Un it�5 . <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IERGROUND TANK{GIST}CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY(VEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> �ERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUSMATERIALS ❑MOTELIHOTEL. ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING 12 OMPLAINT/RESPONSE RECORDS ❑{ETHER(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$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4808 4128/14 <br />