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RECEIVED <br /> / <br /> Lam' V CED SAN JOAQUIN COUNTY ((,J[EHD LOG NUMBER <br /> ,r� �� I I <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 2 5 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> e �'.3qioprk, Telephone: (209)468-3420 Fax: (209)464-0138 Web: wvvw.sigov.org/ehd <br /> ENVIRONITISER HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT(SERVIa f !� <br /> APPLICANT:�i) R CJ I NX—I'L S) NJ H BUSINESS/AGENCY: <br /> ADDRESS: PO {1 Y <br /> pptirt. T CITY/STCATE/ZIP jk5AA'V,4Ic <br /> PHONE (1): 3'')O tt)�! �j PHONE (2): J34 �5�- ( 6 v I FACSIMILE: <br /> Please allow 10 business days from date of application submittal forthe records to be available. <br /> Staff will contact you to arr Tge IaIn appointment date and time to review the requested records. <br /> El CHECK BOX TO EXPEDITEFEE <br /> S $122P E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YSP <br /> SIGNATURE OF APPLICANT DATE I S <br /> Electronic Information: ❑ List❑Ma -Description: 13& <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name city Unit 1 <br /> 2. <br /> ❑ Unit <br /> 3. 4 <br /> 4. Unit 3 <br /> 5. <br /> 6. J i.��CJ �iles 0unta <br /> 7 <br /> 8. 1✓� <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 9 ❑SOLERGROUND TANK(UST)CLEANUP SITE(LOP) El MEDICAL WASTE FACILITY <br /> ID WASTE FACILITYNEHICLE <br /> 'OTHER CLEANUP SITE(NON-LOP) E]HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) PfOOD FACILITY ❑DAIRY <br /> rO�OVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> L?n RDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS ' <br /> LN41-ERED PERMITTED FACILITY �❑��-���oP+ObUSPA El LAND USE APPLICATION SITES <br /> ❑TATTOOIBODYPIERCING LJv MPLAINTIRESPONSE 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 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 he 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 files will he 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 ONLY*** <br /> wv e1. US i �4ie , 1W GL.eroi[ee LA v;,, cly <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD48-88 ' <br /> 4/28/14 <br />