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RE�?,�' \ �ED R • EHD LOG NUMBER <br /> I V SAN JOAQUIN COUNTY <br /> JAN 13 2015 ENVIRONMENTAL HEALTH DEPARTMENT G® �t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL <br /> HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ZAMAN5",S � <br /> � f5-fgaL'� T"BUSINESS/AGENCY: C �q <br /> ADDRESS: 2_Sn- E msT-Le �i S TSL CITYISTATE/ZIP: �J}3L]Yy CA / S�r66 <br /> PHONE (1): Orj(7tI ( bu 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 /> ECK BOX TO EXPEDITE REQUES/T• 'SFL. ASH O CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SI NATURE OF APPLICANT / , r DATE <br /> Electronic Information: ❑ List❑ Map—Description: I 2� <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city _ ❑Unit 1 <br /> 1• 153 E. tlh fA. int f`/ <br /> J2. I ❑Unit 2 <br /> 3. <br /> 4. RrUnit 3 <br /> 5. <br /> 6. Ld Unit 4 <br /> 7 <br /> 8• ❑Unit 5 <br /> 9. <br /> 10. 1 ❑Unit 6 <br /> 3-15 <br /> Sp€cific Date Range of Information Requested: From to. 'n <br /> 1/ ENVIRONMENTAL HEALTH DEPARTMENT FILES (0 <br /> M <br /> -UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ElMEDICAL WASTE FACILITY ❑SOLID WASTE FAnCILITYNEHICLE " 111�( <br /> 9/OTHER CLEANUP SITE(NON-LOP) [:1 HOUSING ABATEMENT E]WASTETIRE <br /> L^O" DERGROUND TANK(MONITORINGIREMOVAL) F1 FOOD FACILITY El DAIRY Y WW <br /> t@ ABOVEGRQUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> EHAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL Toll ETS a•1{5 <br /> ❑TIERED PERMITTED FACILITY ❑PQOLISPA El LAND USE APPLICATION SITES <br /> F-1TATTOOIBODY PIERCING OMPLAINT/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 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 pmwill he 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 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 ONLY°*` <br /> 1-13-15 NA 4CZ'4frn4{m fr". A". Ud +e.\ <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> EHD 4806 4/28114 <br />