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EHO LOU NUMHI:H <br />M"ECEIVE� SANJOAgUINC0E86> DN ll SIOd 'y 'deg awl PaAla)aa <br />E IRONMENTAL HEALTH DEPAR ENT <br />SEP 5 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd �f <br />ENVIRONMENTALHEALTH <br />PERMTISUMCES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: a I Ie (e BUSINESSIAGENCY: Ail 6os.eal+aa..+5 <br />ADDRESS: ?-!Sob Ca-n..j vv U'LAS6112 CITYISTATEIZIP:,(ree�/.� gy597 <br />PHONE (1): �-L5-)'1 GF- fXQO PHONE (2): FACSIMILE: <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Please allow 1 ti business days from date of application submittal - "Tentative only - must he confirmed) <br />[]CHECK BOX TO EXPEDITE REQUEST- 5125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT, zkaa DATE 9I5 2013 <br />Electronic Information: ❑ List❑ Map -Description: I <br />FILE ADDRESS <br />EHD USE ONLY <br />unit <br />Street# Street Name <br />City <br />Ol nraa.e ST <br />To f-kto, <br />s Unite <br />MP� us <br />I+a <br />.Unit 3 <br />2. <br />q, <br />ga0 rr �. STT <br />c <br />a <br />Ld'unit-4- <br />8. <br />Unit 5 <br />8. <br />(3 Unit e <br />10. <br />9 <br />Specific Date Range of Information Requested: From to <br />�J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />LIQ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FAC NEHICI�E "- <br />1 �� <br />�THER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE Gj kis ro <br />NDERGROUND TANK (MONITORINGIREMOvALjj. ❑FOOD FACILITY DAIRY (C(`( 3 <br />�VEGROUND TANK ❑ CHICKEN RANcw DOG KENNEL ❑ WASTEWATER TREATMENT FLANT <br />AZARDOUS WASTEIHAZARDOUs MATERIALS tw— ❑MOTSUHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ OOLISPA [jLAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING - OMPLA.INTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 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 (209) 454-01319 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 EHO 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. <br />Z0/Te <br />siwi-InSN00 I3V <br />61'" i/1 1`m M aIle Mr <br />66099PLSZ6 OT:TT ETOZ/90/60 <br />