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RA IVE <br />SAN NTY <br />JUL 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br />T�1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ENVIRONMENTAL H T�Lrff hone: (209) 468-3420 Fax: (209) 464-0138 Web: vvww.sjgov.orgi„.._ <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: T,r'Lll ��U� St �✓� - BUSINESS/AGENCY: <br />ADDRESS: l ?,-I �1 '� �x -� E?, iy�•�" , _ , ,� Sl�;,-� CITY/STATE/ZIP: WtL(( LA- c'i44i ,ejr -7 <br />PHONE (1): ! �,S '� c'�U I PHONE (2): Cl S' -A. U,;, t t c;? FACSIMILE: f I. S . `i fv. `II `t I. <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 -'$125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN,3 BUSINESS DAYS <br />L- CtF'_t\IATIIDC nC ADD1 11ZAKI <br />t <br />IElectronic In El ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />y <br />Street # <br />Street Name <br />City <br />J_ti C%'VL Lrif Copi1Ai <br />2. <br />I �' <br />3. <br />1 - �'✓i+J :r� j�4 t) ,,: h <br />:i't t ;�(�:i <br />I i�ST ST <br />M(o� <br />(] Unit 3 <br />4. <br />2.(;':rJ <br />5. <br />�fll`, 1 <br />Fps i Y ligu; �1;- <br />Unit 4 <br />6.E <br />7. <br />El Unit S <br />.:�.i6 :5_"7_. % 0 l.,J' <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />U,11UN ERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE ^�ER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT E] WASTE TIRE <br />Liu DERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY 2s'- } <br />ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT Iv(A <br />❑ HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ <br />TATTOO/BODY PIERCING 2-6OMPLAINTIRESPONSE 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. 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 />CI Lc� :;+-1 t i � . I 'k2 (.-0 2531v� lcu.> - � •,� t � u <br />tto 31 q I - lei, � bC a <br />_,�;� <br />t' PMP fc�_s C.nm �J ,TS C c�Y 3�-71 11 A trpc'Li � f1.5'��`L� <br />-7- <br />--- <br />acs zip Ill +j i i �' r;, -' . p wpca <br />8•u <br />JIZ. /If I A tta� P,� ✓ r cd tnCld���- �P F t r.riN <br />kbj —C,I <br />Pi? 0-z:bt�egI 4- M0%307, 71vil Atr,•� usr f- <br />;nsMU', P62 -31W1 St1nAk.(1 5000 -Al -fffl- Ih211 <br />I -A i L indhim rki .v, �-t lP. nn I uv Ll� - cam°A <br />