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RECEIVE® <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> DEC. 3 0 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTIt 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVICES lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECOILS RELEASE APPLICATION /l <br /> APPLICANT: dv, ra—M USINESS/AGENCY: <br /> ADDRESS: � L-� l CITY/STA E/ZIP: Md <br /> C J <br /> PHONE(1). PHONE(2): %FACSIMILE: o - 3.s` ::y <br /> Phase ailow 10 busigess day's from date of application submittal for the records to be available. <br /> Staff will contact you to arrange ran�a�oi�tmen date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$1NFEE ��l/AS CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YS <br /> SIGNATURE OF APPLICANT DATE ` <br /> - r � <br /> Electronic Information: ❑ List❑ Map vDescription: <br /> FILE ADDRESS EHD USE LY <br /> Street# Street Name City <br /> El u it, <br /> /�� <br /> 0 � ��1 �im G (LP t j uiG � J <br /> 3. 3 L %� T,N�gory <br /> 4 3 0/i �s <br /> c�ov�l33j M (pf�! l�'Unit3 <br /> t <br /> 6. <br /> 0 40 ` m nit <br /> -)b I J (o P d OA m&vctAd6dkti1e 46r -ea ck7 ❑ Unit 5 <br /> 9. , <br /> 10. <br /> . ❑ Unit 6 <br /> Specific Date Range of Information Requested: From 13 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> „j UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE - <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> 2'ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ,rHAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES /, <br /> F-1TATTOO/BODY PIERCING ZCOMPLAINT/RESPONSE RECORDS OTHE^ -'LEASE SPECIFY) 4}11 ri els <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS � /h)5 <br /> I <br /> 1. List ur)to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate 1^ <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Addresskvs 1/V"q- <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 /> 4. Any file not returned in the same condition as released will be reorganized by EHD 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 /> -I S 11 M IMP 1;2 (43 7 KV Zn 5 A)pw - tsf x C. <br /> ho <br /> ❑ Records provid d by Staff-PPR Co plete. Staff Name: <br /> EHD48-06 1g: _ ��� 4/28/14 <br /> C/i/7 <br />