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E. <br /> Ell <br /> DAI.LFREE1�}ED,,��,�o` }' ;7 —�, y <br /> -- . I SAN NTY. - <br /> JUL 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ��Pen� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL H&I hone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION R %4H <br /> APPLICANT:���,t�tvl BUSINESS/AGENCY: <br /> ADDRESS: 2. 1`) Tt�c - j?,jy,��. �, r}O �;OLj CITY/STATE/ZIP: W9AjL(- .J.rr� -� UA 9Z4S1 <br /> PHONE (1): Oils. `4 t-• j ill`'I PHONE(2): q SA. f,(;;, t"1 0­? FACSIMILE: 4a Z s . a114&;;. 9 c4?S- <br /> '� � l ."I 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 regl�l!s r rd n y <br /> CHECK BOX TO EXPEDITE REQUEST-'$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSE IN S <br /> 01f-_K1 ATI 10M r-IC: <br /> Electronic Information: ❑ List❑ Map-Description: G-, 1,./ 1 <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name 4)Cji V� City <br /> 50g u lea <br /> 2. <br /> 3. L9 t t S a;r C Lkl+_tl <br /> 4. " �.(;':3] S1-� Sa it. �v , dt ' Si-�c�L� 'r) �(/ CiC3 12Unit 3 <br /> /s• ❑Unit 4 <br /> I t[ <br /> q4. <br /> [1 ✓�OC�� Zi ❑Unit 5 <br /> 9. f , <br /> 10. ❑ Units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [j UN ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> W ERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUSMATERIALS ❑MOTELIHOTEL. [j PUMPER TRUCK/YARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY 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$125 deposit prior to review. `BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHO 48.06 4/28/14 <br />