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�b 18 1412:46p p.1 . <br /> -- ND. 5216 P. 1 <br /> Feb. 18. 2014 11 :24AM San .';aauin County <br /> ,�+ c EHD LOG NUMBER <br /> DATE RE fj yr 1V GD SAN JOAQUIN COUNT <br /> �K[r�'V L� 2p1Q ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB l 8 1868 East Hazelton Avenue, Stockton, CA 95205-6232ov.or lehd <br /> w � <br /> Telepho 149)468-3420 Pax: (2DB) 464-0138 Web: wW.sj9 9 <br /> lV1RdNMTISt HVIBLIC RECORDS RELEASE APPLICATION <br /> PEFfh �!s <br /> LCi BUSINESSIAGENCY: <br /> APPLICANT: I \ � s `� u ' <br /> � �+ CITYfSTATEIZIP: ��lCroti Ll�. I Sia I <br /> ADDRESS: 33 FACSIMILE: <br /> t/ PHONE 2 0 .�'(vG� ' 1�-- <br /> PHONE(1): `( X31—d v � ) Time: /a /4 /) I <br /> TENT TNE-APPOINTMENTDATE _il: I <br /> 73 tFlease allow 10 buslnesa days fromd. of ap calico aubmlttal-'TenQUE only. <br /> must E IN 3 BU d) <br /> AYS <br /> !;Jj� Cj b' HECK BOX TO EXPEDITE REQUE -$125 (CASH O LY)- QUEST PROCESSED �U�NESSao� <br /> SIGNATURE OF APPLICANT o J/1 <br /> Electraniclnformation: ❑List❑Map—Description: <br /> END USE ONLY <br /> FILE ADDRESS <br /> FI <br /> Street <br /> Street Name cityUntt 1 <br /> 1, a <br /> 03 C v� <br /> ❑Unik2 <br /> 2. <br /> 3. <br /> 'I661ft 3 <br /> 4. <br /> S. <br /> � It4 <br /> 6. 1. <br /> 7. 3"n)es (3v_ <br /> B. it •f �. ( . ,��is l ❑Units <br /> 8. <br /> t ck; <br /> [)Unit 0 <br /> 10, to <br /> SpetifieDateRange ofInformation Requested: From <br /> ENVIRONMENTALHEALTHDEPARTMENTFILES SOUDWASTEFACiLRYNEN16LE <br /> )�if DERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACLITY r❑y <br /> HOOSINOABATEMENT E]WASTE TIRE <br /> W9 HERCLEAHUPSITE(NOM•LDP) ❑ []DAIRY <br /> UNDERGROUND TANK(MatIrFORiNGIREMOVAL) ❑FOODFACIUTY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCHI DOG WASTEWATER TREATMENT PLANT <br /> KENNEL ❑ <br /> ❑p UNIPER TRUCKIYAROICHEMMALTOILETS <br /> �AWDOUS WASTEfHAZAROOUS MATERIALS ❑MOTELMOTEL El LAND USE APPLICATION SITES <br /> G yT(EREO PERMITTED FACILITY ❑POOLISPA <br /> ❑TATTOOIBODY PIERCING ❑CDMPLAINTIRESPONSE RECORDS ❑O1HER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONbAY•FRIDAY 8:0D AM.5:GOPM(EXCLUDING H011OAY3) <br /> 1. List up to ten addresses to the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one fila typo MUST be selected. Fax to(209)464-0138 ormall to the address Indicated above. Address <br /> ranges will not beaccepted-for additional assistance with file addresses,contact the EHD. Applica0ons received after <br /> 3:00 pm will be processed the next business day, <br /> 2. The EHD will notify fhe applicant if any EHD files exist_ An appointment for review will be confirmed approx (i0) <br /> days atter raceiptof applicaBon. The Ries will be held fora maximum of five business days far review. Appointments <br /> b,luu,"um claoduled accord!3. A file that is aetwely being worked an by EHD staff may not be immediately available for review. A now application may be <br /> submitted when the Ille is available. <br /> 4. Any Elle not returned in the somL74=130 a condition as released will be reorganized by EHD staff at the ex epee of thea �(icant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. E AREAHSE <br /> i' <br /> "D°.Records provided;6yi5taff<F?PRtGompl�te'.':Stafl Name;= ' 17U72 <br /> Received Time Feb. 18. 2014 11 :31AM No. 5220 <br />