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AU g, 13. 2013 4: 28PM No, 0021 EFP�,ONUMBER <br /> __`R E-C �L SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT O <br /> AUG 13 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMITISEFIVICES PUBLIC RECORDS RELEASE APPLICATION."SAPPLICAfION BUSINESSIAGENCY: <br /> APPLICANT: SeZ <br /> h <br /> ADDRESS: I1�5 N ° �IYSf �t+i � CITYISTATEIZIP, 54,�3ICgSII�" <br /> � <br /> PHONE(1): (�� (ODIC r PHONE (2): �/?� zyg,Q��B FACSIMILE HD 3I S�lQ2� <br /> r1= ATIVE°APPOINTMENT DATE: USS fav w-t Z7 Time: ORS^ <br /> (Please allow 10 business days from date of appllc on submittal -'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE ST-$125 (C SH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE t 113113 <br /> Electronic Information: 0 List ap-Description: yr Or 04 kZ h a lleaI&I a'td S <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> v <br /> �.Unit2 ) <br /> no N Nf Yt �,�� <br /> T>�� J►1'C C r I J�G���, �[]Unita <br /> LL7) <br /> I/A Unit <br /> 1 �@ <br /> /Z Ci <br /> t7. <br /> 8 Unitls <br /> [}-Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From <br /> as PAi 16f a 0, s to C ��n <br /> ENVIRONMENTAL HEALTH DPARTME T FILES `,�- <br /> �N EDICAL WASTE FACILITY LID WASTE FACILITYNEHICLE Nv � <br /> [�UNDERGI20UND TANK(UST)CLEANUP SITE(LOP) `H' <br /> OWOASTE TIRE <br /> [OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT IRY <br /> F- NDERGROUND TANK(MONITORINGIREMOVAL) F1 FOOD FACILITY WASTEWATER TREATMENT PLANT <br /> If ABOVEGROUND TANK ❑CHICKEN RANCHI DOG FENNEL �,{ <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL Lir :UMPERTRUCKIYARDICHEMICAL TOILETS <br /> IERED PERMITTED FACILITY ❑POOLISPA UfAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PFRMIT RECORDS ARE AVAILAULL FOR REVIEW: 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 be selected. Fax to(209)464-0138 o the address I dicate above. d afters <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. A p <br /> 3:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant if any EHL)files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of five business days for.review. Appointments <br /> should be scheduled accordingly, <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the fife 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 pllcant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. �,ox _ .. uum <br /> WO W <br /> R ❑ Records provided by Staff'-F?PR Complete. Staff Name: 914112. <br />