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SAN NTY JUL 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ENVIRONMENTAL HF�L TTPPLFR hone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION %1H APPLICANT:T'r'u)-<-u ti�5i�.�� ' - BUSiNESS/AGENCY: ADDRESS: ^'+ Z� 1J�I�'-4�" 1�,1yC� � +�t Sl�� CITY/STATE/ZIP: WALA- C ,. �, G44 :444 S i- PHONE(1): PHONE(2): G S' {. (.G'a, L4-1 C-1— FACSIMILE: q Z S l i VI Please allow 10 business days from date of application submittal for the records to be availa Staff will contact you to arrange an appointment date and time to review the rel�ested f cor� , y CHECK BOX TO EXPEDITE REQUEST=$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN,3 BUSINESS DAYS] QIF'_A�ATI IDC �C ADPLiv viva civ.)... Electronic Information: ❑ List❑ Map—Description: ?i i �.. % i:), )7 WJ HCl' /i N- FILE ADDRESS EHD USE ONLY Street# Street Name 1 �4)Gi� 1 city ^� •,I Cl/ v/ iY V 1. 50i,)u S. IR,- ne o/.-�; W 2. i 3. 4. _ .i "N3bO .n. 1?4 x , � K V`�uCCJ Unit 3 i5 jJ t�-1'v a3/— WCW Si,U,4,: �� ('l > 173 71' /6. i/ Unit 4 7. 8\ I '')'k JX. �`1 �. :)s_.. t ��V ii' �Oc 7i ❑Unit 5 9. 10. ❑ Unit 6 Specific Date Range of Information Requested: From to � ENVIRONMENTAL HEALTH DEPARTMENT FILES LJ UN ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE Q'G ERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY ER'ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEM[CAL TOILETS ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES ❑TATTOO/BODY PIERCING OMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will b'e held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY' ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 4128/14