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EGENED <br /> SAN .JOAQUIN COUNTY EHD LOG NUMBER <br /> AUG 0 7 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,.Stockton, CA 95205-6232 tl7 V <br /> ENVIRONMENTALHEATLMphone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ./%T�it�6C� JAL- /-/BUSINESS/AGENCY: , ,WILKS��V[rGJ ��¢f10h <br /> ADDRESS: 3�Jd j-r�xTl+iL Tc/2�CCL CITY/STATE/ZIP: 9�w Ck(cl '15_M <br /> PHONE(1): S'/U^ /- 3S`I6 PHONE (2): L/'z? 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 an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)<PEQUEST PROCESSED IN 3 BUSINESS DAYS ✓ �1`r <br /> SIGNATURE OF APPLICANT — DATE Oq,- 07';- <br /> Electronic <br /> 7"Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Name City <br /> 1• 2Lf Z50nS!lMtl� � Y�' I1'1AIVrL-z rMP rr� cA _ STr <br /> 3/e 2. .S c zr_6 'f C L Lt-cn V ❑Unit t <br /> 3. 6L1 ❑Unit 2 <br /> �S 4. ( ❑UnIt2H <br /> ,J/�� <br /> 5. r�`' 1M � / <br /> 6, © <br /> (1'1 Unit3 <br /> 7. L(Unit4 <br /> 8 IVEITE MITIGATION <br /> 9. <br /> 10. ❑unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �ry <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) F-1MEDICALWASTE FACILITY El SOLID WASTE FACILITYNEHICLE <br /> %OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UE] F1NDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> HBOVEGROUND TANK CHICKEN RANCHI DOG KENNEL WASTEWATER TREATMENT PLANT <br /> AZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING Q COMPLAINTIRESPONSE 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. ***BOXED AREA-EHD USE ONLY*** <br /> ��1va>a c.►,ew- >< fV <br /> bY-1 Y0 Pw 2 ve <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4M6 7!1115 <br />