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DflKIV-E WED 41 SAN JOAQUIN COUNTY 0 EHD LOG NUMBER <br /> DEC 2 3 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ( ! <br /> ENVIRONMENTAL HEAL' <br /> TTele hone: (209) 468-3420 Fax: (209)464-0138 Web:: www.sjgov.org/ehd � <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: S-mkimCbJ � CL (Z1L BUSINESS/AGENCY: ! ' , <br /> ADDRESS: PC) FOk (&'-1,tt CITY/STATEIZIP: � �s�l <br /> PHONE(1):0)609- Q�c(� PHONE (2): FACSIMILE: <br /> TENTA E"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-•Tenfavve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUE -$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_ <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS n EHD USE ONLY <br /> Street# Street Name city D <br /> ('@ \ti Aitil <br /> V 1 S�b L,L�T 1A�I Tfir <br /> 6V z. cvl�i� <br /> 3 /❑ Unit i <br /> 4. <br /> ❑ Unit <br /> 5. <br /> 6. / <br /> M Unit4 <br /> 7. <br /> 8. <br /> p�Unit 5 <br /> 9. <br /> 10. <br /> 0 Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONME AL HEALTH DEPARTMENT FILES yy <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY OLID WASTE FACILIT EHICLE %- <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT ASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL V FOODFACILrrY AIRY i.3-I3 <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS- TELIHOTEL UMPERTRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY OOLISPA AND USE APPLICATION SITES <br /> TATTOOISODY PIERCING CO MPLAINTIRESPONSE RECORDS THER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un 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-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 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <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 /> (—Z— Ov, (02 0 <br /> j` r©%A wl <br /> U'5— <br /> -9-Reeords-provided-b af€-PPR-Complete:-saff-Name: <br /> EHD 4M6 <br /> 914112 <br />