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169J EI-F, IG NUMBER <br /> SAN JOAQUiN COUNTY <br /> IL— 0 <br /> 113 ENVIRMENTAL HEALTH DEPARTMENT <br /> SEP 20.!5 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 7/V <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/e <br /> �NVIRONFAENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION 11. E C 07 Y <br /> APPLICANT: BUSINESS/AGENCY.1- CDUj-Lj Pu-blrE WY-V-S <br /> CiTY/STATIE0P: <br /> PHONE (1): PHONE (2). FACSIMILE: Lto) vql C1 <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 /> F1 CHECK BOX TO EXPEDITE REQUEST-$130 FEE " R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPIL <br /> l.A11T C DATE <br /> Electronic Information: [] List 0 Map-Description: <br /> FELE ADDRESS <br /> Street 9 Street Name city EHD USE ONLY <br /> F F, <br /> 2. El Unit 1 <br /> El Unit 2 <br /> 4. <br /> 5, <br /> sot) <br /> Unit 3 <br /> 1 :3L4(v qON_/n 16& kaA q 11,5�1&.eu <br /> 7. V-& V-Da� <br /> 9 EYU nit 4 <br /> aS�iT �T -ATION <br /> �MIC� <br /> 'U2/(-o 1 T On V,9 (N'� 6P <br /> 6-7- <br /> to <br /> Specific Date Range of Information Requested: From . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ,MEDICAL WASTE FACILITY SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) _>ZHOUSINC,ABATEMENT WASTE TIRE: <br /> UNDERGROUND TANK(MONITORING/REMOVAL) []FOOD FACILITY DAIRY <br /> RABovEGROUND TANK 'SCHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIKAzARDous MATERIALS ❑MOTELIHOTEL tPUMPER TRuCK[YARD/CHEMIOAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPAAND USE APPLICATION SITES <br /> El TATTOO/BODY PIERCING Z� <br /> ZCOMPLAINTIRESPONSE RECORDS [I OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEVV- MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <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 <br /> box(es). At least one file type MUST he selected. Fax to (209)464-0138 or mail to the address indicated above. Address <br /> ranges wlIl 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 appro)Urnately ten (10) <br /> days after receipt of application, The files will be held for a maximum of five business days for revlew. Appointments <br /> should be scheduled accordingly. <br /> 4. Any fire not returned In the same condition as released will be reorganked by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$1310 deposit prior to review. 'BOXED AREA-EHD USE ONLY-` <br /> Staff NnmG- <br /> '2015" 3 : 08PM=No, 9598 <br /> Received T � me ep, 17 <br /> EHD 4-a-400 T1115 <br />