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'REPOEIVED <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> DEC. 3 0 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEAL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVICES %ephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd' <br /> PUBLIC RECOIRPS RELEASE APPLICATION J,l\ <br /> APPLICANT: L n /r' USINESS/AGENCY: �J <br /> ADDRESS: Vv [X,,& CITY/STA E/ZIP: / ! p '/ <br /> PHONE(1). PHONE(2):_ 3 FACSIMILE: zap - �j�j7 "-y(� 7 <br /> PYffase ailow 1U business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an ap tmen date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$! s CAS, CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS D YS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE CWLY <br /> Street# Street Name City ' M <br /> 11 U.Pit1 <br /> 1 3 f.L� /te/' � 711 <br /> �,p z <br /> 6ZOG(CQ t. ounii ''❑! <br /> Uni <br /> 3) L l2 L0 tt MA't I T/No COBS <br /> 4 ll yj /y P, ,nit 3 <br /> ffqi . 0 o <br /> 6. Co �� I l�#I h1 nit <br /> 8' -)171 5Jf0 P nnl I/ legs / ❑ UnitS <br /> 110. 1 1 <br /> ❑ Unit <br /> Specific Date Range of information Requested: From3 to <br /> ENVIRONMENT HEALTH DEPARTMENT FILES <br /> .JUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILI Y1VEHICLE - <br /> 7 THER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) [j FOOD FACILITY El DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH[DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELMOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA El LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING OOMPLAINT/RESPONSE RECORDS \I OTHE-"LEASE SPECIFY) /S ' <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8DI <br /> :06M-5:OOPM(EXCLUNG HOLIDAY` <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,/&.Tbox(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address indicated above. Addres <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. I <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 /> I <br /> I MP k/- ( U37 2n .m.W WLsf Q * � - <br /> 0 <br /> ❑ Records provid d by Staff-PPR Cofnplete. Staff Name: <br /> EHD dB-O6 � `� i/ � 4/28/74 <br /> �r I l 7'�- 14�1,P7 yl <br />