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.;DATjSQv. 22. 2015 2: 13PM N0. 1911 EIV. 30NUMBER <br /> a1/ SAN JOAQUIN COUNTY <br /> RECEIVE) ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232'@ <br /> QCT 14 Zfflglephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd EF <br /> f l,wI N)j\jg4FMTAI PFAITH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SERy10: <br /> APPLICANT: M U-A MCO), rl(c BUSINESS/AGENCY:SJUU10LI r IlblfL kl6KS <br /> ADDRESS: (SSI G E� Ct�S2 {1p(1 /11/C CITY/STATE2lP: c� 20 C <br /> PHONE(1): ZZM)L(&N-3 PHONE(2): FACSIMILE: L Lf(er/^ 7i' C11 <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 data and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQ $130 FEF(CA,$R OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /{'`-&__1L. DATE <br /> Electronic Information: ❑ List[I Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name city EHD USE ONLY <br /> 1. w wa4eK O((d%e_ S` (,ILjWA I t"^+tp-�'O, L6 Ew1�C01!) <br /> 2. �cJ3 CJ N- VL4 l am nvr61%,1 n F1= K}TjnHI <br /> 3. 313(1( r1 I�Gt6y1 lavlJelL(, iteSMt(pI 1 tt2 <br /> 4. 322U F. LA'n (_ cv1 vyi S£uv11 -^ by_1 [a'GIt 2H IU�r <br /> s. 3Z�5� G, G" co- on i e, -CO Its-wt-►5 <br /> r. -7,11,a fl r�- 'Tapa ori vr' atxk'Dr, q au it4 <br /> S. Ir-t3S N . 7 PO Vi-_, ,cu&"-cls ST <br /> 9. 321Qe7I 1r. -T(�akla 41— pr-i�e' S ocLf�n n1.,�r_ <br /> 10. 317/S r '`(D,�YN(,�(r1ov K_ JnvY M%a&ml) W Units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) .E�MEDICAL WASTE FACILITY SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE <br /> yrJ 1)�`'UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY d DAIRY <br /> ABOVEGROUND TANK ®CHICKEN RANCH/DOG KENNEL y�I y WASTEWATER TREATMENT PLANT <br /> }f9 HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEL(HOTEL .SPUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> u TIERED PERMITTED FACILITY POOL(SPA Ea LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ®COMPLAINT/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 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. "'BOXED AREA-EHD USE ONLY* <br /> 7 LA4wwe, .3- 77-33 1i?e o IWMI C0()077!,67 t A(00 zt A,e.k,,44— <br /> W VJ vile (-.sf ;1715 . <br /> n o........4.- .-rr..,:A—A y1• 06.Tfc ane �O-'_�_`_ Staff Name: <br /> Received Time=Se p. 22. _2015= 2: 09PM=No..9621 <br /> END 49-09 711115 <br />