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x;29/2014 13:31 91664866 ADR PAGE 01/01 <br /> ISO <br /> I0 <br /> NN <br /> (7� O [P <br /> C .. EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 2 9 2014 ENVIRONMENTAL NEALTF# DEPARTMENT <br /> 1868 East Hazeiton Avenue, Stockton, CA 95205-6232 t <br /> eNtJI��J ',jj�,; ,�� L E � r Telephone: (209)468-3420 Fax: (209)464"0138 Web. www_sjgov.org/ehd <br /> rDc0""" f;ERV10ES <br /> PU,,B''AAL''IC RECORDS RELEASE APPLICATION <br /> APPLICANT: (3}CU6t Al5kc BUSINESSIAGENCY; Aub EVV;k(A4WYVt• j 6 ltWj) <br /> ADDRES$: 22S SON Shcc�" 4 2(2- CITYISTATE/ZIP: S ccf)tl-a L'2/ CA '?SK <br /> PHONE(1): 916 `t 11-066 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of epplicatlan cubmtttel-•Tenfaflve only-must bo oonflrmod) <br /> ❑ CHECK eOX TO EXPEDITE REQUEST-V2 PE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 8USIN.ESS DAYS <br /> SIGNATURE OF APPLICANT � %' (D <br /> DATE � 70i¢ <br /> Electronic information: ❑List❑ Map--Dascription: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroat 4 Street Nzma Clfy <br /> —1 Untt 1 <br /> afZ� <br /> 2. U <br /> ❑Unit 2 <br /> 4. <br /> Q Unit 3 <br /> 5. <br /> B, dUnit 4 <br /> 7. ' <br /> 8, Cl Unit 5 <br /> 9, <br /> 10. Q Unit A <br /> Speciflo Data RanGs of Information Requested: From fn Ztu <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [✓�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT [j]SOLID WASTE FACILITYIVEHIGLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑.FORD FACILITY ❑WAST;TIRE <br /> UNDERGROUXD TANK(MONITORINOIRE90VAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEwATERTREATMENT PLANT <br /> 9TIERED PERMITTED FACILITY Cj-MQTELIH DTEL ❑PUMPER TRUCKIYARDIChEMICAL TOILETS <br /> ❑TATT001130DYPIERCIRO ❑POOLISPA ❑LAND USS APPLICATION SITFB <br /> ❑ MEDICAL WAU3'E FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELI,AND SEPTIC PERMIT RECORDS ARE AVAILALILE FOR REVIEW: MONDAY-FRIDAY 6:00 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(263)484-Q13Q ar mall to the address Indicated above,- Address <br /> rangoe will not ba 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 /> Z. The)=HD will notify the applicant if any EHO files exist. An appointment for review will be confirmed approximately ten(40) <br /> days after receipt of applicaflon. The flies 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 F:HD staff may not be Immediately available for review, A new application may bo <br /> submitted when the the Is available. <br /> 4, Any file not returned In the same condition as released will he reorganized by EHD staff at the expense of the applicant. <br /> Future file raviewe by the eame applicant may require a$125 doposK prior to review, <br /> ti- 0 5 roil <br /> e DASAG 81t1t1 <br /> Received Time. Oct. 29. 2014 1 : 24PM No. 7431 <br />