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01/01/2010 <br /> VED 20933983 MIDCAL INDUSTRIA PAGE 01/01 <br /> RECEI <br /> DATE RECEIVED EHD LOG NUMBER <br /> AUG 2 6 2015 SAN JOAQUIN COUNTY ;,, <br /> ENVIRONMENTAL HEALTH DEPARTMENT ' <br /> ENVIRONMENTALHEALTIH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMITISERVICE a ephone: (209) 468-3420 Fax: (209)464-0138 Web:www,sjgov.org/ehd <br /> PUBLIC REC <br /> /O <br /> RDS RELEASE APPLICATION <br /> APPLICANT: p BUSINESS/AGENCY: /Z6 FS`T39 <br /> ADDRESS: 14 g t)e & -/7YJ r1CW *CT'--/;1/ CITY/STATE/ZIP: 4!Te�az 9S2/ <br /> PHONE(1) PHONE(2): N FA I : SWY <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- y'i4FFE(CA O ,HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,/f/� DATE X--- 2-5 —Ir- <br /> Electronic information: ❑ List❑Map-Description. <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Nome City Unit 1 <br /> C/-jdJ2C/i <br /> 2. arm(, Y6/VI v I� �^"^P, K�IUS-(�c/�- <br /> �f \. <br /> L unit 2 <br /> 3. 1 <br /> a. Unita <br /> ro�iaft _;�(es G„ac <br /> s. <br /> Unitb <br /> ET. /q (). . ✓-1 <br /> a. �1•a-15 ikr��I: <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> SpecificDateRange of Infomlallon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> r- % ERGROUND TANK(UST)CLEANUP SITE(LOP) F-]MEDICALWASTE FACILITY 1_-]SOLID WASTE FACIUTYNEHICLE <br /> 0THER CLEANUP SITE(NON-LOP) ElHOUSING ABATEMENT ❑WASTETIRE <br /> FRVINDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> rI^k,,�BO'V'EGROUND TANK L]CHICKEN RANCH)DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> n,,InwARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL E-1 PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY 21'N <br /> OOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING OMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00Pm(EXCLUDING HOLIDAYS) <br /> 1. List uc 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 ormail 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 ton(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 5130 deposit prior to review. —BOXED AREA-EHD USE ONLY""' <br /> P�JjAavAh—o. IAV./ r�nkU L'll L / 500 Ut �o IrN U tl18 S '1 <br /> -1-1,¢, File (9� ►, : <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 66-e6 _ <br /> 08107/74 <br /> Received TirrAug. 25. 2015 7: 55PM No. 9420 <br />