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DATEWB`�41"-,-�- -`) EMD LOG NUMBER <br /> SAN JOAClUlN COUNTY vvvv <br /> - <br /> NOV 121', ENVIRONMENTAL HEALTH DEPARTMENT <br /> 7868 Fast Hazelton Avenue, Stockton, CA 95205-6232 5010 <br /> ESR EN-tAiTfql,qAfiione: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/eh <br /> PERMlT/SERVi C l:_;: <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTAMQA -14BUSINI SSIAGI=NCY: 0k <br /> L� <br /> ADDRESS: r }-` '4'f 9, CITY/STATEIZIP:Sh(e`�6¢ ) <br /> PHONE (1); )190 I a� 3 PHONE (2): 91FACSIMILE: <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 /> SIGNATURE OF APPLICANT CHECK BOX TO EXPEDITE �REQUEST s13 ��(CASH-t�- x ONLY)-REQUEST 17Roc DATE,SED BUSINESS <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE.ADDRESS JEHD USE ONLY <br /> Street# Street Name City' _ 13n1t <br /> 2. <br /> 3. <br /> 4. T �c_�-a h� /� um re �.S_I S�l_ _ _.-..- . _0 Unit 3 <br /> 5. <br /> CA _ eY1.l- SITE MITIGATION <br /> �. � �_ <br /> rC � _rL nlS�_�:?_ e _ Vim! �d ❑ Unit 4 <br /> 7. <br /> 9. <br /> Specific pato Rahgo of information Requested: From to <br /> 1777 7T. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEWCAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) 4OUSING ABATEMENT ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑bHICKEN RANCH/DOG KENNEL. ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTE;L ❑PUMPER TRUC KIYARDICHEM ICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LANAI USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE 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 tan 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 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 /> Futuro file reviews by the same applicant may require a $128 deposit prior to review. `"BOXED AREA-EHD USE ONLY"' <br /> J <br /> Q Records provided by Staff-PPR Complete.Staff Name: <br /> Ewo is-ua <br /> 5111115 <br />