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D <br /> OjGNjE <br /> SAN JOAQUIN COUNTY 1.W C (D <br /> JUN 2 4 2014 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Tephone: (209)468-3420 Fax: (209) 464-0138 Web: wWW.sjgov.org/ehd <br /> ll <br /> FVIRONMENTAL PERMIT/SERVICES L <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /qtr-o �����-s-�ze.�¢� BUSINESS/AGENCY: <br /> ADDRESS: 3125 jnn, i,c� CITY/STATE/ZIP: (.ve„/nom} G i UQ cj V51 <br /> PHONE (1): W9-2-97-7727 PHONE (2): FACSIMILE: <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-$125 FEE CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑Unit 1 <br /> )Vv 1. 2Sao� I�a.6x Ro( � t1N1ti1 NB=C'GSj� <br /> 2• _ Unit 2 <br /> C 3. <br /> 4. r <br /> [�Unit <br /> 5. 11 <br /> 6. <br /> ,(]Unit 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I�5 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE Q <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE j jk L' <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY (p a <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELMOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOL/SPA [SLAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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)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 ONLYa"''` <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 4128114 <br />