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a® 01/01/2010 00:19 20933986 HIDCAL INDUSTRI PAGE 01/01 <br /> ep <br /> EHD LOG NUMBER <br /> e®® E N _ SAN JOAQUIN COUNTY <br /> SEP 10 2015ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,.Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www,sjgpv.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> / JIZym ` p � <br /> APPLICANT: / //0 1 -A -3) <br /> ADDRESS: CITY/STATE/ZIP: 517d <br /> - <br /> I, <br /> PHONEIGrp�ra`f PHONE (2):�O�J �3/ ~ FACSIMILE: r—gr-- �� �✓ 7/ <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 appoin t date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 2E ASH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /tom DATE 9 '/ <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name City <br /> re r <br /> 4w r pA7 5 <br /> • 2. //3 5: SToCKT�N fir_ rocxra� 5 ( �W I cQ <br /> 3, ❑Unit 2 <br /> 4. r�� GFI�C LJoU Unit 2H <br /> IL <br /> 6. <br /> 7 u .�fllta <br /> 8 <br /> 19/SITE MITIGATION <br /> 9. <br /> 10 ❑Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ODERGROUND TANK(UST)CLEANUP SITE(LOP) F-1MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> (�U DERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY El DAIRY <br /> [V9OVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> L'I%ZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY. ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE 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 un 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 EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The flies 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 <br /> oofile <br /> �reviews by the same applicant may require a$130 deposit prior to review. *"BOXED AREA.EHD USE ONLY... <br /> i. "y W0✓�l�nCvn ��(�a-S �lr tnn�. l e IG�S/Y J C- J ¢� �Nr1 L' <br /> (,'l" V"f. � fr <br /> auk Lt tN (�Of7 f7t7S 1 rn 7t Elts ED f I I ) <br /> d4C C lw`A CO 0 t 10 382 sly l llJ File l 9r �l�i N O(, <br /> El Records provided by Staff-PPR Complete. staff Name: <br /> nuts <br /> Received Time Sep. 10. 2015 9, 13AM No. 9539 <br />