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28 2013 11:36AM Enviro Assess 877493 page 1 <br /> EHD LOG NUMBER <br /> 00 °�5Mp\/�� SAN JOAQUfN COUNTY � r <br /> ° N �9 ENVIRONMENTAL HEALTH DEPARTMENT <br /> l V <br /> OCT �� 2� � 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 /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 5G/V lyr;4 �'[l BUSINESS/AGENCY: 25V I;/ �SSr�S$' <br /> ADDRESS: 0C)?C /�S CITYISTATE/ZIP: <br /> PHONE(1): Zia 8� Zi*e - OSD PHONE(2): 11�92 <br /> 9— 1 �� FA•C._SI�MILE:TENTATIVF•APPOINTMENT DATE: PLS. LL iF f�t�fs FOsI ime: <br /> (Please allow 1 D business days from date of application submittal-`Tentative only-must 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 �f fig' aO/3 <br /> Electronic Information: ❑ List ❑ Map—Description: fC <br /> FILE ADDRESS EHD USE ONLY <br /> ❑Unit 1 <br /> SStreet Name City <br /> treet ` <br /> 1. 6 1 0 /'Koe 4eo�' <br /> 2 � ❑Unit z <br /> 3. b <br /> 4. /El Unit 3 l\ <br /> 5. l ask-Cf? S\) <br /> 6. lv f /U, <br /> 7. (�r✓ C��3o l(s <br /> ❑Unit 5 <br /> 8. <br /> 91 <br /> ❑Unit 6 <br /> 110. <br /> to <br /> Specific Data Range of information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYNEHICLE <br /> Xj UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑ <br /> HOUSING ABATEMENT ❑WASTE TIRE <br /> OTHER CLEANUP SITE(NON LOP) DAIRY <br /> UNDERGROUND TANK(MONITORING IREMOVAL) FOOD FACILITY ❑ <br /> ❑ <br /> ABOVEGROUND TANK CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> MOTELIHOTEL ❑PUMPERTRUCKIYARDICfiEMICALTOILETS <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS 0 POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY <br /> �]C <br /> E]TATTOO/BODY PIERCING COMPLAINTIRESpONSE RECORDS ❑OTHER(PLEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:DOPM(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 appropriatebox(es). At least one file type MUST be selected- Fax to(209)464-0138 or mail to the address IndicateAddress <br /> d above. <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 a 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. Anew 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 b EHD staff at t snse <br /> 7 �.f the aican, <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> `1.. ,.. +•.�,_�. r. u,». '+�`"'�,"'."+ r,w� H t s 2 , s rte_ �p'4.„ - � ,yam" <br /> P•- ' ., w....�� w«C,.wn 1"""',4,r' "� c'�iu rviyirx 7th. w!nrsf'"" <br /> - w r' 4..�ili' w u.'«'."��F wh Tu r "..r.+.+_+ w..K • r. .*Yi .'..�, .,pr <br /> {{ riny u,a.Vr... c •9kaw. wuel.�. . .Is w'7.t F w..w."1 ..r."'"'r <br /> '•�ii'rii'1. 'Y.01. 1.ONMI.. � �'� .-� 4'•Y- � . ' <br /> -- Iri•.r.W 1; �m"R::T�'^A' - Nr� e Y ..av;', � L .�. ,C..t. �..:,««'ti"..'.'d..�"" +.n. . <br /> .ry <br /> EHD 48-06 <br /> n _ _ ..._ J T:_ 0,.+ 10 O(11l 10•dRPM Nn- 066 <br />