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® �" U I I r IYI J ��0 1693 N G NUMBER <br /> i � Lfl�9_�� SAN JOAQUEN COUNTY N r <br /> EIV Nf�iENTAL HEALTH DEI�A►�T�Er�T Q f <br /> _ �. _ <br /> a SEP . 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: WWw.Sjgov.org/eh <br /> I�NVIRONFAENTAL HEF,L�?-1 rILE COn <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> NY <br /> APPLICANT: -A-gk 1 11/l �L1,�iY1fS/"}`/ BIISII.�E~SS/AGENCY:STGD_tS�_'1j I�Ub/rG Wc�� <br /> qrq nrsrn n, y -fir�t o i lV� , Ci6Y/STATS/ZIP: <br /> rwuMcC30. 3 1 y :r �G�1 V- - I ld <br /> PHONE (1): C � �t0 �3D�� PHONE(2); FACSIMILE: (t0q) yca— ZgC� <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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEECASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��C� DATE <br /> Electronic Information: [] List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> On _o�[ol Cl�) sfoc <br /> 2, .�Lt13El GY+��I u- n�,�/ Unit 1 <br /> 3. JLU� ' �il� � (Z-O /I (F) SlU it(��1 Cl� j Unit2 <br /> �. 3Y3 2 % CVV-n k-a kC C S�D cam/ <br /> []'Unit ii-i <br /> 5. _3�q5o <br /> 6- 3u P-„a� c S-�c��cvn �l �1. P ' <br /> `Unit 3 <br /> r. V g-ou�( ) s � �a ' <br /> 'Unit 4 <br /> -rr MrrIGATION <br /> s. `��� � •T �n we CN .��c��_I�F f _ �_ <br /> _ 1 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 15 MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SETS(NON-LOP) HOUSING ABATEiMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) []FOOD FACILITY DAIRY <br /> AsoVEGROUND TANK CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/KAZARDOUS MATERIALS ❑MOTELIHOTEL PUMPER TRUCK/YARD/CHEMICALTOILETS <br /> C]TIERED PERMITTED FACILITY POOL/SPA LAND USE APPLICATION SITES <br /> F-1TATTOO/BODY PIERCING rSCOMPLAINTIRESPONSE 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 flies from the list above by checking the appropriate <br /> box(es). At least one flle type MUST be selected. Fax to (209)464-0138 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 reorganlzed by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. 'BOXED AREA-EHD USE ONLY" <br /> r-1 C2®rnrr�c �r,�erert�rt !3�s ce.��-Dszo ria•-,.,'•e•,�,• Staff Nama: <br /> Received Time=Sep, 17, =2015_ 3; 08PM=No, 9598 <br /> EHD 48-06 71715 <br />