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0SWON NVW[ �IOZ '9Z 'daS[) uW!j PaAiaaa� <br /> EIVED SAN JOAOUIN COUNTY ` <br /> M <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 - <br /> SEP 2 6 2013 Telephone: (209)468-3420 Fax. (209)464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENTAL HEALTH Ll Lui "i <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> a <br /> APPLICANT: 6-Cu,2m BUSINESS/AGENCY: R F <br /> ADDRESS: A�-0 0 [p,yyv►A.o 'i a Q kD _ CITYISTATEIZIP_W GQ hU a CA ft`��9�_ <br /> PHONE(1): (? Q013 PHONE(2): 9 1 333 9 2 0( FACSIMILE: q� �q ID Ia D 9 9� <br /> TENTATIVE"APPOINTMENT DATE: — 7 Time: in <br /> (Please allow 10 business days from date of application submit-tat-'Tentative only-must ba confirm d) <br /> ❑ CHECK BOX TO EXPEDITE RE $125 FEE(C H OR CHECK ONLY)-REQUEST PROCESSED IN:3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: List❑Map— ascription: <br /> FILE ADDRESS EHD USE ONLY <br /> �J$treat# street Name City ❑Unit 1 C <br /> --- �,a�.[�� <br /> 2. IOD I C Unit 2 <br /> 3. 5 ot�t ✓t,2t 1' �.� I�I <br /> 4. Unit 3 <br /> 5. <br /> 6 A-UI)t47. /10. ' - <br /> Specific Date Range of Information Requested: From t?/Rn to E I - A 4•� — <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ,��/ <br /> [d DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT F LID WASTE FACILTTY/VEHICLE H <br /> OTHER CLEANUP SITE(NON-LOP) n FOOD FACILITY 4ASTE TIRE <br /> [UNDERGROUND TANK(MONI I'ORINUREMOVAL) ❑DOG KENNEL ❑D IRY <br /> R-IAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> [TIERED PERMRTED FACILITY ❑MOTELIHOTEL UMPERTRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOWBODY PIERCING 13POOLISPA 2tAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u 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(2091464-0138 or mail to thQ address indicated z1bove. 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 behold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A ilia that is actively being worked on by FHD 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 /> EHD USE ONLY <br /> ■ <br /> Bf7111 ■ � <br /> FHO 48-06 son <br /> ■ <br /> te�ie �CJr)d siwi-insN0o I3v RRRggtJq7R bG:CIT PTG7/q7/F.GI •� <br />