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RA I `� • EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY � <br /> AUG 12 201`5 ENVIRONMENTAL HEALTH DEPARTMENT ��,� 11 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL Hftiff h one: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgov.orglehd. <br /> PERMIT/SERVICES <br /> I� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /�/NA?ki Luis BUSINESS/AGENCY: <br /> �/ wJil G�S�/F £r L s <br /> ADDREM 0 CITY/STATEIZIP: ( pgLiivr �r �! C) <br /> PHONE (1): PHONE(2): 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- 30 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> GNATURE OF APPLICANT DATE heh <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# <br /> Street Name City <br /> Ls.s c4a r�r <br /> El Unit 1 <br /> ❑Unit 2 A <br /> C, t i (fir• -(,p ( o,�, <br /> -CopU5-TUnit 2H I� <br /> 4. X <br /> s. Aroo.d L1 Pitt ILO t $Unit3 1' <br /> '-✓tT - <br /> 7. ©Unit4 '1 <br /> 8. - Itj SITE MITIGATION <br /> ❑Unit e <br /> 10. ' <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITY/VEHICLE <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑ <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> G KENNEL El WASTEWATER TREATMENT PLANT <br /> Q ABOVEGROUND TANK E]CHICKEN RANCH/DOPUMPERTRUCKIYARDICHEMICAL TOILETS <br /> ❑/ HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL PUMPER <br /> USE APPLICATION SITES <br /> _❑TIERED PERMITTED FACILITY E]POOLISPA ED _ <br /> ❑TATTOOIEODY PIERCING 2 COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND'SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:o0PM(EXCLUDING HOLIDAYS) <br /> 1. List uD 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 /> I' ranges will not be accepted.Applications received aftdr 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 atthe number noted above. <br /> 3. The EHD will notify the applicant If any EHD files exist. An appointmentfor review will be confirmed approximately ten (10) <br /> - <br /> Id for a maximum of five business days for review. AprAtments <br /> days after receipt of application. The files will be he <br /> should be scheduled accordingly. "cant. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the app <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> (J isw e V 1'I�LvrI� 61n V (04 <br /> G vw ca lar l " w v ka (e 17LA Mlk 31 <br /> WRecords <br /> It oG r a5CI ,,{p.provided by aff-PPR Complete. staff Name: 7111`15 <br /> EHD 46-o6 <br />