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08/01-/Z014 3 : 12 : 15 PM -0400 FAXCOM ANYWHERE PAGE--2 OF 2 <br /> RECEIVED <br /> SAN JOA EHD LOG NUMBER <br /> QUIN COUNTY <br /> AUG 012014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTALHaa%phone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C 1 I 1pr {ihi BUSINESS/AGENCY1M (1✓,rt NCw a� <br /> ADDRESS: 3 CJS S4, z06 CITYISTATE/ZIP: a$e✓:]�t G'(� <br /> PHONE(1): ]6- S PHONE(2):3&2 31n_g56/ FACSIMILE:In 7 fZf&l- <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REOU T-$12 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE I jZjlj� <br /> Electronic Information: ❑ List[] Map-Description: <br /> FILE ADDRESS EHD Us ONLY <br /> Street 0 Street Name City nit 1 <br /> 1. t 05 <br /> Unit 2. <br /> :.7 <br /> 14-6 0 WPW <br /> 3. <br /> .......... <br /> --- ...E]Unit 3 <br /> .. ..... <br /> 6. <br /> .... ..... ............ Unit 4 <br /> 7. <br /> 8. <br /> ... ....... <br /> 10. <br /> nit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 MEDICAL WASTE FACILITY SOLID WASTE FAUU/TY�})AAV�/EHICLF� <br /> OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT MWASTET(RE ST71C�S '-W(T�� <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY -7-11 <br /> (KABOVEGROUND TANK 0', ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> M HAZARDOUs WASTEIHAZARDOUS MATERIAL50" ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY OC ❑POOLISPA <br /> ❑TATTOO/BODY PIERCING ❑LAND (PLEASESE SPECIFCATIONY)SITES <br /> l�COMPLAINT/RESPONSE 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)464.0139 or mail to the address Indicated above Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business ay. <br /> 2. For assistance in identifying the nature and content of END records,please contact END at the number noted above. <br /> 3. The END will notify the applicant if any END 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 /> 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 /> 14 <br /> le r Gia <br /> e- <br /> I �. <br /> 0 ; <br /> I MA q,7-1U• (stol Min / l//�, <br /> FI Recoirdr v.� r1 by C4 ff DDR COMplete. ,. <br /> EHO 98-06 1. j 7 © I 9 a ou n f D 5 d- (et 51 D n tl end <br /> Received I'imeRNug. �10°214iT � �0.�6sr roY E °pF `f°v3 "� sFom ¢ UpgfysiO` <br /> I � �. <br />