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i■ D+" <�= ° �� PRr SAN JOAQUIN COUNTY No. 0 13 9 EH P. 1;NUMBER <br /> I ■ <br /> ■ <br /> INNAPR 0 9 201ENVIRONMENTAL HEALTH DEPARTMENT IN 0 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> NV11 eNNIENT/�LH�II&Fhone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd CR <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: VVILI'3 -S r".1- BUSINESS/AGENCY: ► f C-4 V)P0,4-'p <br /> ADDRESS: I5J3 $ CITY/STATE/ZIP- <br /> PHONE (1): 5-10-Q-q 7-- 1985--009-PHONE (2): _ FACSIMILE: -V-10-ef 9(,- 9� <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 appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$13 �__ !S:!]T��RCHECK�ONLY)�-RIE_zST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANDATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. El Unit 2 % <br /> 3. L <br /> 4. ��0 G (`-G 5T �� unit3 <br /> 5. <br /> 6. 0 Unit 4 <br /> 7. ()rL jel, 7{1�ec AJ <br /> 8. \hD L Unit 5 <br /> 9. n� <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> JNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYtVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) F1FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL �NASTEWATERTREATMENT PLANT <br /> ,gHAZARDOUSWASTEIHAZARDOUS MATERIALS Q MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING �COMPLAINTIRESPONSE RECORDS E]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 he 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 OtJLY` <br /> I (L&Ae� k�VltC' r 3400 K' o PL%-k, GJt�� v`w, CD. <br /> 11 Records nrovided by.Staff-PPR C_omolete. Staff Name: <br /> Rece oveed Time=Apr. 9.�201-5 = 3: 11PM=NoA496 <br />