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i 0 <br /> DATE RECEIVED EHD LOG NUMBER <br /> 00 SAN JOAQUII�I COUNTY <br /> ENVIRONMENTAL ( EALTH DEPARTMENT 4A <br /> OCT 2 8 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/c-hd <br /> ENV•,.. ..,;dMTAL MENM <br /> RERfdi71SECltM <br /> PUBLIC RECORDS RPLEASE APPLICAT€OH <br /> APPLICANT:__',�anlut 1>\a�av1I- BUSINESS/AGENCY: <br /> ADDRESS: _.3(>S� �nG�uS� InQ ���It CITY/S-TATE/ZIP: VJIs� Snrrnrn }� <br /> PHONE('I): q)jy - 31;— )Ll3 LI PHONE(2): FACSI'ViiLE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application.submittal-*Tentative only-n;ust be ccnfirmad) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Descripficn: <br /> FILE ADDRESS `— <br /> SCreet# Street Name City ❑Unit 1 <br /> ,�,_ G <br /> 2. cowp &0 ❑Unit 2 <br /> 3. <br /> P(Vjal Lk ATC54 ull tmp'-� <br /> 4. D <br /> _. E2 Unit <br /> ��// ��) ✓ <br /> 6• pd Unit4 <br /> 7. <br /> B. <br /> ❑Unit 5 <br /> 9. <br /> 16, ! &?Nm s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL PIEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEICAL t1lIASTE FACILITY ❑SOLID WASTE FAClU YNEHICLE <br /> OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT <br /> ETWA.STE TIRE <br /> FLUNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER T REA.TME',rr PLAiTT <br /> A2ARDOUSWASTE/HAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AIN-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 chaeking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(ECB)464-0138 or mail to the address indicafsd 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 END 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,evieod. :L,ppcintments <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. Anew application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released villi be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a£526 deposit prior to review. .'_'BOXED AREA-=HDUSE ONLY <br /> Li � <br /> f4ir ;IGI. mQ V10,6 ... v ta <br /> ne . <br /> .'El Rec:rds`provided by Staff-PPR Complete. s <br /> EHD 48-06 ---' <br /> e/C/t2 <br />