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■` 07/b7/2014 14:11 FEDEX OFFICE 1039 Y PAGE 01 <br /> ■■ • • EHD LOG NUMBER <br /> 4 REGIEVED SAN JOAQUIN COUNTY <br /> ■ <br /> JUL 0 7 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 f <br /> Telephone: (209)468420 Fax: (209)4G4-0138 Web:vvww.sjgov.org/e <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: d✓ le4q&EL /lit iD /J tS BUSINESSIAGENCY: �'-lam(2 c <br /> ADDRESS: 4eto -m— CITYISTATEOP: Z_,y5 ✓fA)46Z,55 C,4 "/0101 <br /> PHONE(1): PHONE(2): ZIA M —34 7t> FACSIMILE: !z(3 o(j <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 /> XCHECK BOX TO EXPEDITE REQUEST-$125 FEE CASH OR CHECK ONLY)=REQUEST PROCESSED IN 313U INFSS OAY <br /> NT _ _S — <br /> SIGNATURE OF APPLICADATE <br /> Electronic Informatlon: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street%� <br /> Street Name City Unit 1 <br /> 1. V-.3 24 NA E AI MMI LlS /,cc ' <br /> _t ( <br /> 2. 3 V t` y NPPj ccs i❑Unit2 <br /> 3. / <br /> z <br /> . �` eUnit3 <br /> 9. I ,ri 21UnH4 � <br /> s <br /> 7- <br /> 8. ❑Unit 6 <br /> 8. <br /> 10, ©Unas <br /> Specific Date Range of Information Requested: From to ` <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES `` N'0 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑r-�MEDICAL WASTE FACILITY SOLID WASTE FACILITYMEHICLE <br /> OTHER CLEANUP SITE(NowLOP) 4 HOUSING ABATEMENT LJWAsT TIRE <br /> UNDERGROUND TANK(MOmTORINGIREMOVAL) ❑FOOD FACILITY Ll DAIRY <br /> n X7711 <br /> ABOVEGROUND TANK ❑CHICKEN RANCfi)OOG KENNEL ASTIWATERTREATMENT PLANT <br /> AZARDOUS WASTEIHAT.ARDOUS MATERW_S ❑MOTELIHOTEL ❑ UMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERmom FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ATTOpIBODYPIERCING XCOMPIAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FmoAY 8:OO AMS:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up t4 ten addressee in the space above. Selectthe types)of tiles from the Ustabove by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address Indicated above" Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance In Identifying the nature and content of END records,please contact END at the number noted above. <br /> 3. The END will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held fora maximum of live business days for review. Appointment$ <br /> should be scheduled accordingly. <br /> 4. Any file not rewmed 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$126 deposit prior to review" —AP ED AREA-END USE ONLY— <br /> G Gfl�.e f fI S CCTe/) <br /> 1 C UkS - 067 <br /> 023 td-ul o 6 � o6Jll tacl r � S/o C H3a41 IC' <br /> CSL OF .-0 3�. ✓ G <br /> D\ <br /> ❑ Records provided by Staff-PPR Complete,StalfName_ 5 98 <br /> 9HO4848 ElZA"A <br /> Received Time Jul, 1. 2014 2: 10PM No, 6510 <br />