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. 02/02/2015 12:33 503--786—�SAN JOAQUIN COUNTY 5 <br />FEDEX OFFICE 5PAGE 01 <br />DATRECEIVED EIVED F -HD LOU NUMBER <br />�w <br />I� FEB 0 2 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 `'7 <br />ENVIR0NMENTATpjkW4Rne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: blcYL1 BUSINESS/AGENCY: EBI con'sq, <br />ADDRESS: W? SE P079V 1V2hu CITY/STATE/zlP:Mil kle, 0g�2 <br />PHONE (1): sub -04-Z15t PHONE (2): <br />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 a appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE R VEST 1 FEE ASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT , DATE 02 -02 -15 <br />Electronic information: ❑ Llst ❑ M p Descrlption: <br />FILE ADDRESSEHD <br />_ <br />USE ONLY <br />❑ Unit 1 <br />Street # <br />Street Name <br />City <br />2. <br />_._ / Unit2 <br />3. <br />Unit 3 <br />Q, <br />5. <br />=.�M <br />r `tk-i^�W j NJ�n�vtJra <br />�i �iie5. <br />N- p llnit4 <br />g, <br />❑ Unit 5 <br />g, <br />dunIt s <br />10. <br />Specific Data Range of Information Requested: From <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />AaOVEGROUND TANK <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS <br />TIERED PERMITTED FACILITY <br />TATTOOIBODY PIERCING <br />MEDICAL WASTE FACILITY <br />HOUSING ABATEMENT <br />FOOD FACILITY <br />CHICKEN RANCH/ DOG KENNEL <br />MOTELIHOTEL <br />POOL/SPA <br />COMPLAINTIRESPONSE RECORDS <br />to <br />50 SOLID WASTE FACILITYNEHICLE <br />❑ WA$TETIRE <br />❑ DAIRY <br />I�1 WASTEWATER TREATMENT PLANT <br />❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-S:OOPM (EXCLUDING HOLIDAYS <br />1. List un 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 (2091464-0138 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 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 some 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. "'*BOXED AREA - EWD USE QNLY^ <br />tAq r<""I Ke,,61e&'L'1 QUILM' <br />CI Records provided by Staff -PPR Complete. staff Name: <br />00101114 <br />Received Time Feb. 2. 2015 12:33PM No.8002 <br />