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M <br /> EMD LUG NUMUtK <br /> V � 1.�/ SAN JOAQUIN CCS 6�'oN f l l OIOZ 'S 'd;S ;Wil paA I a0;d <br /> E.4VIRONMENTAL HEALTH DEPAR-1 iviENT lot. <br /> l <br /> SEP 5 ' 2013 1868 East Hazelton Avenue, Stockton, CA 9520576232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL FFALTH <br /> PERMMSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ 1 U,":1 `le i. BUSINESS/AGENCY: AF.T CaZ�Sul+ati.�5 <br /> ADDRESS: 7 �jU La i �yt� E^ �/i CITY/STATEIZIP:GJal,,t,t-(_r k.&6/911S9ti <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE; Time: <br /> (Please allow 10 business days from data of application submittal-"Tentative only-most be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT- DATE I �2Di�i <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ,Unit 1 <br /> 0� aY� o f . usr),.k�r,�P F� lyli 1900 F ' h 5( T C c,:- 5� Unit2 <br /> D MP <br /> J G i-(�M <br /> 4. � Unit 3 <br /> g• 04,it 4 I <br /> 7. <br /> $, ❑Unit 5 <br /> 9. <br /> 70. 0 Unitli <br /> Specific Date Range of Information Requested; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILI YNEHIC <br /> ❑ THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE I e� I�l <br /> [�-RP-� NDERGROUND TANK(MONITORINGIREMOVAL)./—. ❑FOOD FACILITY <br /> L]DAIRY <br /> [R OVEGROUND TANK+-.�, ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENTUNT <br /> IAZARDOUSWAsTEIHAZARDOUsMATERIALS-t ❑MOTEUKOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑OOOLJSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING I COMPLAINTIRESPONSE 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-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 EMD 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$125 deposit prior to review. <br /> ilk <br /> L'HD d9•Q6 (i$� , 1 J Ili d' O ` JlQ6> tM (� 1/ , ""v 6 k Bf 2 <br /> n� <br /> 7,0/TO 39VC4g S1Nvi-inSN00 I3V 66099VLSZ6 OT:IT EtiOZ/50/60 ��, <br />