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Apr, 1. 2015 3^: 06PM No. 0124 P, 1 <br /> REG EV 0 SAN JOAQUIN COUNTY • EHD.LOG NUMBER <br /> on APR O 12015 ENVIRONMENTAL HEALTH DEPARTMENTfly <br /> 1868 East Hazelton Avenue, Stockton,, CA 95205-62326232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: Www.sjgov,org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT(SERVICES PU(BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Wtewp BUSINESS/AGENCY: �R}�� Ln✓lrovlrne✓t � <br /> ADDRESS: I "33 D ���, ee�- CITY/STATE/ZIP:_ nyi�a, <br /> PHONE (1): x'10-?s 17 5Jjg �x30-')1PHONE(2): FACSIMILE: 5710-j?& S`39� <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-$130 FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE -3 I- 13— <br /> Electronic informatlon: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHn USE ONLY <br /> �St+Cet r Street Name city — <br /> unh, <br /> 2. ck <br /> or w Do "jV5" 61112 3. IDT 9"ej <br /> ` 4 � V <br /> ,LJUnita / <br /> s. <br /> Unit <br /> 7, n <br /> Unit S <br /> 9.. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requeated: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> fSUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY <br /> PT <br /> NUE]SOLID WASTE FACILITYNEHICIE <br /> P OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY IRYAsovEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL �WDA <br /> ASTEWATER TREATMENT PLANT <br /> JWHAZARDOUS WASTNHAZAROOU$MATERIALS ❑MOTEL/HOTEL PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA LAND USE <br /> ❑TATTOO/BODY PIERCING COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE ISPECIFY)ON ITES <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Listup to ten addresses In the space above. Select the type(s)Of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)484-0138 or mall 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 EHb 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 roquira a$130 deposit prior to review. "'BOXED AREA-EHD USE ONLY"" <br /> ,7mlq f7o N 041 ()F:A rnrc-- w 1 e' car 1113 S�Eku , Jl <br /> Cl Records provided by Staff-PPR Complete. Staff Name: <br /> END 4s-oe <br /> aeiovta <br /> Received Time Apr. 1. 2015 3: 15PM No. 8439 <br />