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Aug. 13. 2013 4: 28PM No, 0027 Eh L 2"NUMBER <br /> CMF <br /> �r a�� SAN .10AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 13 2013 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 /> PERMITISEFMVICES PUBLIC RECORDS RELEASE APPLICATION �ni <br /> APPLICANT: S� <br /> Ya SI BUSINESS/AGENCY: +� a r <br /> ADDRESS: I1�5 O ° CITYISTATEIZIP: <br /> PHONE(1): dS (0o(0 r f ' PH "OfaPPI10 <br /> ) zyg'Q��S FACSIMILE HD 318r1�� 1 <br /> rE ATIVF'APPOINTMENT DATE: A}V w-1 Z7 ` <br /> Time: O�� <br /> (Please allow 10 business days fromon su mittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE ST-$125 1(C SH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE f)113113 <br /> Electronic Information: LISt ap-Description: yv% 0►^ 0{ IZb14 4-i 4 eQ 1s(Gihe1 S <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name Clty ❑Unit 1 <br /> ' .Uhlt 2 <br /> ZZo 1 u CCS cls <br /> do h NWo <br /> S1Yc C r I '! #C'�f A Unita .� <br /> ti <br /> ,Q-Unit4 <br /> 7. <br /> Uniti5 <br /> 8. <br /> 8. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested' From QS a <br /> Lj A• lq39s to C U r n <br /> ENVIRONMENTAL HEALTHIDEPARTME-14T FILES <br /> VUNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY OLID WASTE FACILITYNEHICLE �{/� 4v_WASTE TIRE <br /> [OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT <br /> ,U NDERGROUND TANK(MONITORINGIREMOVAL) E]FOOD FACILITY Q WIRY <br /> ASTEWATER TREATMENT PLANT <br /> [?ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL <br /> RIJAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL Dl UMPERTRUCKIYARDICHEMICALTOILETS <br /> E�IIERED PERMITTED FACILITY ElPOOLISPA u LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:001"M(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 208 464-0138 or m il 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 flies 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 Jr.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. —_- OXIl'VOW <br /> R I� Records provided by Staff PPR Complete. staff Name <br /> 214112 <br />