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D TFzRF10E{ EHD LOG NUMBER <br /> E SAN aIOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTIf <br /> �%j <br /> DEC 0 2 2015 1868 East Hazelton Avenue, Stockton, CA 952 - Am) <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> E110RONItIiENTALHEf1h1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SOwze Gvrv�1 �rlC ` 13USINESS/AGENCY: <br /> ADDRESS: �t( �8 1�1UCI(nlY1l_ � CITY/STATEIZIP: <br /> PHONE (1): PHONE(2): FAXORE-MAIL: ^ pJ�G(�$��rrQ�iavfo• <br /> Please allow 10 business days from date of application submittal for the records tobe avails Ib e. " rrd- <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> KCHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 72� � DATES 2j <br /> Electronic Information: [List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY ^ <br /> Street At Street Name City / <br /> 1. a7 IEQSi-- = Awk <br /> 2. 02� 5 .;� ❑unit 1 <br /> 0 <br /> 3. 31Lp <br /> q 0 5� <br /> r�tn ayP�/lL1Q- Sb ❑Unitz 12� <br /> 4' 3to � t <br /> —oz 2H <br /> s. 2a LI E . S r) No nit3 <br /> 6. �" <br /> acyl <br /> {rL t( S Unit3HM <br /> 7. Ud'na 4 <br /> a• < SITE MITIGATION <br /> 9. <br /> 10. ElUnit 5 <br /> Specific Date Range of Information Requested: From I'i 7b to 2015- <br /> , ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACIUTYN HICLE <br /> OTHER CLEANUP SITE(NON-LOP) E:1 HOUSING ABATEMENT E]FOOD FACILITY 11'(qle5 Fo�Ln7 13 <br /> UNDERGROUND TANK(MONITORING/REMOVAL)17- ❑WASTE TIRE ❑DAIRY,POOLISPA�f„ C(D 16L->U)2-1-{S <br /> ®ABOVEGROUND TANK ' ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTE C' ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑TATroo/SODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00AM-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 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 same condition as released will be reorganized by EHD staff at the expense of t e applicant.`Z716Ml�Ier�' <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. I2_,_i5 P �IQ v fill <br /> " BOXED AREA-EHD USE ONLY`"" 4•U5-f fil�{2� Z�I] /yfyyN�i")l.J�' f" .p]➢.i <br /> uY11 atw5 <br /> MDO <br /> d d a a 5106 <br /> 1-6 <br /> Ai J 3 0 ilio; <br /> - 08 31 0 (Ld <br /> ffo yix I I YS f et 5106 )d 69 4 7 6 f+5 il: - 768 51 NO TSln U`2TffP for <br /> 3310/11°;Ael: 12- 1s: trrn 1855rpf 5106); 5; )„ " Vr,, F'le Fa,- a 4t e4AVrkl2, �a <br />