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REG�"'�.t" EHD LOG NUMBER <br /> R ENE SAN JOAQUIN COUNTY <br /> FEB d 9 2015 ENVIRONMENTAL HEALTH DEPARTMENT dJ <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Es <br /> RCWMENTALHEALephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> °k PERM'T'SER CES' PUBLIC RECORDS RELEASE APPLICATION <br /> 12 <br /> APPLICANT: V/arDMC C BUSINESS/AGENCY: / !C F i 13/3c'C/4�i i � <br /> ADDRESS: ! 'g g PL4a. �jst-/ CITY/STATE/ZIP: ti< l/ I(� C/f /4S�/O <br /> PHONE(1): PHONE (2): FAX OR E-MAIL: <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(CASH"OR�CHEpCK.ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> S NATURE OF APPLICANT Ski GfyytF�I DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City 0 <br /> 31, <br /> NO eV <br /> ❑Unit 1 <br /> OL <br /> I ❑Unit 2 <br /> r 7�G Q1 i "� ej � A)olnJ Unit 2H <br /> of/I( <br /> 5 'A-1 i fj ♦ •tet I, P 19Unit 3 <br /> • F.k Na ��� nit 3HM <br /> �• +, c 0 6 Unit4 <br /> 8. 51 SITE MITIGATION <br /> 9. <br /> 10. ❑Unit 5 <br /> Specific Date Range of Information Requested: From - -to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILrTY1 EHICLE (J�/t} <br /> HER CLEANUP SITE(NON-LOP) [:1 HOUSING ABATEMENT ❑FOOD FACILITY �j �I--at " /p <br /> fBNDERGROUNo <br /> TANK(MONRORINGIREMOVALK ❑WASTE TIRE ❑DAIRY,POOLISPA LUl!'F <br /> OVEGROUND TANOC ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTE-j ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> HAZARDOUS MATERIALS "r❑l T:ATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> E-1TIEREDPERMITTED FACILITY 'y54yOMPLAINT/RESPONSE 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 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 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 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$130 deposit prior to review. <br /> *"BOXED AREA-EHD USE ONLY" <br /> -►I- coo 4lobs ; I -e 'e w <br /> ) f T�va�p <br /> V5 74 S r 3� 75z to It o ti° <br /> 1y3 k _ 1- 9 ole <br />