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EHD LOU NUMdtK <br /> � v1 �VED SAN JOAQUINCO�86 ''ON V ll EI0Z 'S 'd;S awij P;AI ;3;� <br /> ENVIRONMENTAL HEALTH DEPART HnENT <br /> SEP 5 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 /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:,kAre,w Id[.� BUSINESSIAGENCY: AFT Cowatf&uE5 <br /> ADDRESS: '7-Got) CITYISTATE/ZIP:VAIv,4t-(rf ek(AI9Lf S4ti <br /> PHONE(1): (4Z —1 q9—k= PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE; Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-most be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9/5/2D I.3 <br /> Electronic Information: ❑ List Q Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> t'^ Street# Street Name City .Unit 1 <br /> QJ t� Cl)1. Ol QYA o 5� c ` usr� P N t lyli v 2\ 1900 F "-K Ct T C 0:1, S-T Unit2 <br /> 4, .171 Unit 3 <br /> 6. I0'tlnit 4 l <br /> i <br /> 7. <br /> $, ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICL�F\` /, j.�� <br /> Q QTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT El WASTE TIRE Gj (C IV t I <br /> ❑�--�/`�NDERGROUND TANK(MONITORINGIREMOVAL)� ❑FOOD FACILITY ❑DAIRY q-jC�'� 3 <br /> L�! OVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> IAZARDOUSWASTEIHAZARDOUSMATERIALS ❑MOTEUKOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> F-1TATTOOIBODY 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 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 EHD 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 EHD staff at the ex ense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> AA <br /> n �' �] q _ L ,, y� <br /> EMD4B-05 v1�� / I �C� '!i l`7 d- Q { 5101) a-J � (/1 �, i111V�IC �� <br /> Z0/T0 S g „'`� SINVrinSN00 Iib 66099PLSZ6 OT:TT ETOZ/50/60 <br />