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P. <br /> Aug. 13. 2013 4: 28PM No. 0027 EF—L NUMBER <br /> EVE SAN .1OAQUIN COUNTY ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT AU <br /> a4. ` <br /> AUG 13 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Pax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH ` <br /> PERMITISEFMCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> ra S1 C.� BUSINESSIAGENCY: +.e �+ r <br /> SQ. . <br /> ADDRESS; 1155 N ° fIVA 5)4-tf, -�) CITYISTATEIZIP: <br /> PHONE(1): jp0(D - ifPHONE (2): (jlVe) z98rQ�i8 FACSIMILE 318—(�Zo4 <br /> TE AT/VE"APPOINTMENT DATE: U-e,5 ffiV t4s Z7 Time: ORS+ <br /> (Please allow 10 business days from date of appllc Oon submittal-'Tentative only-must be Confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE ST-$125 (C SH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE SI13113 <br /> Electronic Information: List ap-Description: Vn V_ .17 tQ li I and S <br /> FILE ADDRESS LHDE ONLY <br /> F- 7, <br /> t# Street Name City ❑Unit 1 <br /> -,ee C om" " ,® 3S _ Unit2 <br /> I p 1�, �,�yt C t— � G�` ti �9� -° ]Unita <br /> - !'lhSK• <br /> o�oC oSl� 9 <br /> do •� � s -. -� � <br /> L �t/`I r Cth�r U nR 46. � <br /> I (7U <br /> unit�5 <br /> , <br /> FTUnit 6 <br /> 10. dW f E <br /> to 14 ✓e <br /> Specific Da—teRa f Information Requested:o - FroQ n <br /> ENVIRONMENTAL HEALTH DPARTME T FILES <br /> [✓UNDERGROUND TANK(UST)CLEANUP SITE(LOP) I MEDICAL WASTE FACILITY IOLID WASTE FACILITYNEHIGLE <br /> OTHER CLEANUP SITE(NON-LOP) F1HOUSING ABATEMENT 0WASTETIRE <br /> u NDERGROUNDTANK(MONITORINGIREMOVAL) El FOOD FACILITY ❑ IRY <br /> Q ABOVEGROUND TANK E]CHICKEN RANCHI DOG KENNEL LjTAND <br /> JWASTEWATER TREATMENT PLANT <br /> RARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL MPERTRUCKIYARDICHEMICALTO(LETS <br /> IERED PERMITTED FACILITY POOLISPA USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PFRMIT 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 tho 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 maXiin0m 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 neti^f application may be <br /> submitted when the file Is available. <br /> d by EHD staff at the expense of the a <br /> 4. Any file not returned in the same condition as released will be reorganize <br /> Future <br /> Future file reviews by the same applicant may require a $125 deposit prior to review. <br /> c <br /> R I� Records.hrovided by StafF=f?PF Cotrlhlete. sta f Namei 914112 <br />