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RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT 90611 <br /> FEB 2 5 2015 1868 East Haze t <br /> ( on Avenue, Stockton, CA 95205-6232 <br /> �3:) ,Zpf,j Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EIVVlRTmLHEALTaO <br /> PERMIT/SRMIT(SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> f <br /> APPLICANT: U R C� I N`l�C I� Si r\� BUSINESS/AGENCY: <br /> ADDRESS: _���� y{1 Yt. CITY/STATE/ZIP:_k(SNptVi4(e C K <br /> PHONE (1): 53O GIR 3 3 ,PHONE (2): S3(3 —SIJ 6n I FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to aLgeappointmentdate and time to review the requested records. <br /> CHECK BOXTO EXPEDITE REQUFEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YS _ <br /> SIGNATURE OF APPLICANT DATE lS <br /> Electronic Information: ❑ List❑Ma —Description: )A <br /> FILE ADDRESS EHD USE ONLY <br /> 7ffStreet# Street Name 1 City 9 <br /> 1. K— L� f �'1�j Le 5 '�W^ Unit 1 <br /> 2. CjAE <br /> ❑ Unit 2 <br /> 3. <br /> 4. <br /> R(Unit 3 <br /> 5. <br /> 6. �c, <br /> J i ®Unit 4 <br /> 7. <br /> 8. <br /> Unit 5 <br /> o, <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> W1NDERGROUND TANK(MONITORINGIREMOVAL) 2-fOOD FACILITY ❑DAIRY <br /> ED-AOVEGROUND TANK El CHICKEN RANCHI DOG KENNEL F1 WASTEWATER TREATMENT PLANT i <br /> NPIE'RED <br /> RDOUSWASTE/HAZARDOUS MATERIALS [:1MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> PERMITTED FACILITY ❑PObL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING FY16MPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1. List uo 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 END 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 /> rj r ek L4l i 14(c. U r I&V c.b ervttee L., v-;,, G . <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 4128114 <br />