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��IL-17 2315 13: 19 FRCIM:TnI.pq & CORY 2093E5E859 C49133 P.1/1 <br /> kphone: <br /> SAN .10AQUIN COUNTY EHD LOG NUMBER <br /> `u 1868 East Hazelton Avenue, Stockton, CA 95205-6232ENVIRONMENTAL HEALTH DEPARTMENT <br /> �,Y �o�Q (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd ,, <br /> NVIRONMENTAL HEALTH <br /> PERMMSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: - (Ie J S BUSINESS/AGENCY: 7� t% GJfi /C <br /> ADDRESS: 3/ K 4/ /y,L shxr- , CITYISTATE/ZIP: 1� <br /> PHONE(1 L G 22? PHONE(2);,20 FACSIMILE.X!G/ <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 dot and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 ' E( SH OR CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7 —/U�-1.� <br /> Electronic information: ❑ Lf ap—Desc on: <br /> LE ADDRESS EHD USE ONLY <br /> Stroot# Street Name City El unit <br /> 2. = 1C' ' 2 U. ..7 .3 > l J ,` � / 71.-.i. 7. Unit <br /> ^ ,��y 1 - - - • � <br /> 3. b� jlli <br /> 4. �NVi��J t{FSfeS . �unit3 <br /> 5. O len <br /> �s �Dnit4 <br /> 7. <br /> B ElLW17l- <br /> s. <br /> Unit <br /> Specific ate Range of Information Requested: From 'f� 13r/S to 7—Z2—e4— <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> PTiERED <br /> OUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> EANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> OUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> OUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> US WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> RMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONsE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to tan addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). Atleastone flie type MUST be selected. Fax to(209)464-W38 or mail to the address Indicated abovoi 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 END at the number noted above. <br /> 3. The EHD will notify the applicant If any EHD flies exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The flies 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$130 deposit prior to review. *"BOXED AREA-EHD USE ONLY` <br /> In'm*y X35 °! rnAJ (L7 DuIt5�$ tre 'I� Hwy fwfzF)ie �r �lsid� w7(g» i, <br /> ® Records provided by Staff-PPR Complete. staff Name: <br /> 4H048-0a 06101114 <br /> Received Time Jul, 10. 2015 1 : 17PM No, 9128 <br />