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03/18/2015 08:08 77585635 RENOCONVERSE PAGE 01 <br /> RECEIVED <br /> DATE RECEIVED� - SAN .IOAQUIN COUNTY EHD LOG NUMBER' MAR 18 2015 �('� <br /> ENVIRONMENTAL HEALTH DEPARTMENT ��� f <br /> ENVIRONMENTAL HEAL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVECES Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC.RECORDS RELEASE APPLICATION <br /> APPLICANT: Ti S�f- -1y firII BUSINESSIAGENCY: rzriveae_ (.6mll6n f <br /> ADDRESS: H.EH.(h_ Hl 11 S1Yeel Svi�)-e- S CITY/STATEIZIP: Eet10, t�y 8q'S02 <br /> PHONE(1): ')'IS 1RL4— 6ij 6q 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-;130 FEE( AS OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SIGNATURE OP APPLICANT Y DATE 13 S <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street R Street Name City ❑Unit 1 <br /> 1. 243 E 1"'orMa Lane S}aGk.fon--- ,.p h�. <br /> 2. ZQScS S4FhoN WAY -... _ 'vF� Unit <br /> 3. 29 SA44-'On Jay <br /> 4. B9 G3CS) lert�' <br /> n�k 5. RS$b ( Kotd(A 15 M?AlaW (r,)d. <br /> L, 6. <br /> D UnIt4 <br /> r r T. / <br /> e�\1105 ❑ units <br /> 9. 1 <br /> 10. Unite <br /> Speciflc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS 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 5:00 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 appropriata <br /> box(es). At least one file type MUST be selected. Fax to(2091464 G138 or mail tot a address inftdeAppxo,. Addres's <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)en(10) <br /> days after recelpt of application. The files will behold 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 /> Fubrre file reviews by the same applicant may require a$130 deposit prior to review. "`BOXED AREA-EHD USE ONLY"' <br /> (rx. I t tAS54 twa 1 5v`k ' I'(A, i✓u �:It ' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Een sena 06701!16 <br /> Received Time Mar. 18, 2015 8:04AM No. 8352 <br />