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■ ng-.2-O-42013 14: 30 FAX 2001/001 <br /> RECEIVED <br /> ■ DATE RECEIVED EHD LOG NUMBER <br /> ■o SEP 2 O 2013 SAN .10AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL 1 68 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT(SERVICC&Whone.(209) 468-342p Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> PUIKIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 601 BUSINESS/AGENCY: _fne.Y'CO <br /> ADDRESS: N51 R i v�r c.f k r CITYISTATEIZIP: - - S CIC rtkrnen+-O- CLQ <br /> PHONE (1): 80 02 PHONE(2): FACSIMILE:(9/6) 280 o60-3 <br /> TENTATIVE'APPOINTMENT DATE:' Time: <br /> :., <br /> (Please allow 10 business days from data of Appi+catir submittal-*Tentative only-must be confirmed) �M <br /> ST_$125f <br /> SIGNATURE OF APPLICANT DATE l �O ,ZQ/ F <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street V /Street Name city <br /> LQ ❑Unft 1 <br /> F4. <br /> i=� a c 4(ee+ nC. p US i ..�c cc�� Unit Z �f <br /> p)' -1 A ,► Unit S <br /> 5• ^ v�,, � t (L A ,.f I V6. <br /> r <br /> J]`Unit 4 <br /> 7. <br /> 8. <br /> Unft a <br /> 9Lj <br /> 10. <br /> Unit 8 <br /> Specifle Date Range of Information Ro�uested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES L ti� <br /> �]C I <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE C <br /> Q -7 <br /> OTHER CLEANUP SITE(NON-LOP) T ❑HOUSING ABATEMENT EIWASTE TIRE o <br /> UNDERGROUND TANK(MONfTORINGIREIMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATM ENT PLANT <br /> HAZARDOUS WASTEJHAZARDOUS MATEkIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITE$ <br /> ❑TATTOOIBODY PIERCING 0 COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in thepace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(os). At least one flie type UST be selected. Fax to(209)46"138 or mail to the address Indicated above, Address <br /> ranges will not be accepted-loadditional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the ext business day. <br /> 2. The EHD will notify the applica t If any EHD files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of appllcatlo The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordin ly. <br /> 3. A file that Is actively being wor6d 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 112n <br /> Future file reviews by the sameiappllcant may require a $125 deposit prior to review. <br /> � .;.r iS)Rh`.,i,ic.�rP i �. >r•.i:-,1 f� ..k:."'— :4:xr-! 'rli5�;"1!.":! <br /> !h::•: •'i:: i.:'.i,iii' ..�+ - 7 ' 1F <br /> .,.',::,',•!"' .:'.'.`�'.;'.........:.:.: �. ',"•'%.. .6P�:(w'P'w.t.:bMTV,riaw�S:F .71N�.!ft+ Rr at,$�U1nnP r.r+'a n.U':M14r�J._ '�,. iyi�1:,'�1G �n •✓�vlya;; ='.ti". <br /> 0 Records provided Sts $pltf.N <br /> Co pt-tom: <br /> ' 9W1 z <br /> Received I 1me Sep. 20. 2013'-•� :41 PM No. 4 <br />