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Prom:Marcus Bole & Associates �.` 11 /'-/2013 18 -21 #014 P.001
<br /> �■ �J FILE V 1 EHOG NUMBE ,
<br /> �■ i ��J SAN .10AQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> NOV 1 2a1 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd
<br /> ENVIRONMENTAL HEALTH
<br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION
<br /> APPLICANT: 1)/ Vl D r E LTf�
<br /> �DLt� BUSINESS/AGENCY:
<br /> w1, P'
<br /> ADDRESS: 10 11 CITY/STATE/ZIP: c✓IfYi4rc�Nn1 c-4-
<br /> PHONE (1): {30-y/S-((o 3 PHONE (2): FACSIMILE:
<br /> TENTATIVE'APPOINTMENT DATE: 11 �l Time: 11 /�M
<br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed)
<br /> ECK BOX TO EXPEDITE REQUE -$125 F (CASH O�/ CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT �l��G%�a�� DATE
<br /> Electronic Information: ❑ List❑ Map-Description:
<br /> FILE ADDRESS EHD USE ONLY
<br /> Street# Street Name City ❑ Unit 1
<br /> 2. (D,41 ❑ unit 2
<br /> 4. p(7 E Amy ST- 1-d/t/ fl,'-F:' ❑Unit 3
<br /> 5. D7BAC /
<br /> 6. Q Unit 4
<br /> 7.
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<br /> 9.
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<br /> 10. -- - -- - - � �)�I lC�NC ) unit s
<br /> Specific Date Range of Information Requested: From -to
<br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES
<br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILfTYIVEHICLE t4 V c)W
<br /> HER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE
<br /> RAU DERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY
<br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT
<br /> (IEZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS
<br /> RED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES
<br /> ❑TATTOO/BODY PIERCING MOMPLAINTIRESPONSE 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-for additional assistance with file addresses,contact the EHD. Applications received after
<br /> 3:00 pm will be processed the next business day.
<br /> 2. 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be
<br /> submitted when the file is available.
<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. E Efin- ON1Y
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<br /> 'EHD 48.06 914112
<br /> Received Time Nov. 17' 2013 5: 19PM No. 4549
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