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D/ 01EIVED � "''EHD NUMIBfR <br /> SAN JOAQUIN COUNTY <br /> � - <br /> DEC 2 3 2013 ENVIRONMENTAL HEALTH DEPARTMENT , <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Tele hone: 209 468-3420 Fax: 209 464-0138 Web: www.s' ov.or /ehd <br /> ENVIRONMENTAL HEALTH ) ) J9 9 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ?�t C-1'k?'1Z_ BUSINESS/AGENCY: R, E n r IADDCo <br /> ADDRESS: b 'E?oX 6Q1l_1 CITYISTATE/ZIP:�S j� 14 4 <br /> L.k 9S0,110 1 <br /> PHONE (1):� (�QS�' Dr14-d. PHONE (2): FACSIMILE: <br /> TENTH VE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of applications ubmittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUE -$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /Z�-2 3 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY / <br /> Street# Street Name City i❑ Unit 1 2-El Unit 2 i <br /> 3. <br /> 4. El Unit 3 ` <br /> 5. f <br /> 6' [I Unit4 <br /> 7. 1 <br /> 8. EJ/Unit 5 <br /> 9. <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONME TA' L HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY OLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) FOOD FACILITY AIRY <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS TELIHOTEL <br /> JUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY OOLISPA AND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING COMPLAINT/RESPONSE RECORDS THER(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 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 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. 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 /> 3. A file that is actively being worked on by END staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 9!4112 <br />