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L07/07/2014 14:11 • FEDEX OFFICE 1Pg9 PAGE 01 <br />M,8g1Vl= U EHD LOG NUMBER <br />!!! ��11l1�� VV 11��SAN JOAQUIN COUNTY <br />JUL 0 7 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 4683420 Fax: (209) 464-0138 Web: www.sjgov.org/e ■■ <br />ENVIRONMENTAL HEALTH <br />l H <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: /.i(Ir✓J(y( rl t1A a P)65 BUSINESS/AGENCY: - (L,c <br />ADDRESS: -400 oDc4m dp -JF- CITY/STATEOP: Z-xX5 XAJ4rF,L€3 c,4 qac <br />PHONE (1): YakS -Y2sf PHONE (2): Zl - /0!3 -3.,,C7b FACSIMILE: �Zt3 Oa ?dFS- <br />ON <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 - <br />SIGNATURE OF APPLICANT <br />Electronic Information: [] List ❑ Map- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />C1 Unit <br />sb%t# <br />Street Name <br />city <br />1' <br />3 <br />A E <br />N <br />MM it U //,,LSP <br />NPP. N(:�Cs I] Unit 2 <br />2. <br />2j <br />(` <br />V1JF Y <br />3. <br />(Unit3 <br />4. <br />'­jr,, <br />17 j (i�lYlZ��l .� <br />e."N <br />I <br />i r.' Ty ct f ,)4741 <br />EiunR4 <br />6 <br />J <br />7. <br />❑ unit 6 <br />s. <br />8. <br />Unit 6 <br />10, <br />Specific Date Range of Information Requ"tod: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILESIC7 <br />UNDERGROUND TANK(UST) CLEANUP SrrE (LOP) ❑ MEDICAL WASTE FACILITY SOLED WASTE FACILITYM111CLE A I""" ��V <br />OTHER CLEANUP SITE (NON -LOP) ❑STEHOUSING ABATEMENT WATIRE SLI` <br />UNDERGROUND TANK(MONROMNGiREMOVAL) ❑FOODFACILIIy [:j DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCH/ DDG KENNEL ASTEWATERTREATMFNT PLANT <br />AZARDOUS WASTEIHAZARDOUS MATERIALS [�MDTELIHOTEL [� UMPER TRUCKIYAROICHEMICALTOILEN <br />TIERED PERMITTED FACILITY ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />ATr00/BODY PIERCING XCOMPlAINTIRESPONSE RECORDS ❑ OTHER(PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 ANI5:00PM (EXCLUDIN(1 HOLIDAYS) <br />1. List ao to ten addresses in the space above. Setectthe typa(s) of files from the tistabova 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 3:01) 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 attar 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 rewmed in the same condition as released will be reorganized by ERD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review.—f)QXED AREA - EHD USE ONLY" <br />6 /VMoIcU rWi.1 oF ifijdelF r "t-* xs,i xs -o62 <br />0�5aL I c�y 16-edo �� o6ill e7 r, 510 r a3�J lav , <br />CQ of Lt L h X3:2 ✓ <br />❑ Records provided by Staff -PPR Complete. Staff name- 6 <br />FHO448-W 4U8M4 <br />Received Time Jul, 1. 2014 2:10PM No. 6510 <br />OF <br />