|
■04/15/2014 13: 06 FAX 310615454 ^^ Z 001/001
<br /> I ■ i ." AI■ DATE IEC! VED FILE C 0 1
<br /> EHD LOG NUMBER
<br /> ■ ,�
<br /> ■ � � � r/fC� '+ SAN JOAQUIN COUNTY
<br /> ■ =. ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br /> APR 5 Wlephone: (209)468-3420 Fax: (209)464-0138 Web: wvvw.sjgov.org/ehd fA
<br /> ENVIRONMEM HEALTH PUBLIC RECORDS RELEASE APPLICATION
<br /> APPLICANT:.� BUSINESSIAGENCY; ENM
<br /> ADDRESS: CITYISTATE2IP:_('j_D\)j 9 `
<br /> PHGNE (1): j PHONE (2); FACSIMILE: _
<br /> TEN 7I IVE`APPOINTMENT DATE: Tlme: 3 Q
<br /> (Plea-5e allow 10 business days from datd of application submtttal-`Tanfaflve only-must be conflrmod)
<br /> ❑CHEC BOXTO EXPEDITE REQUEST-$125 FEE(CASH OR C CK ONLY)-REQUEST PROCESSED IN 3 6 SIN SS DAYS
<br /> SIGNATURE O APPLICANT DATE f I
<br /> Electronic Inf9rj atlon: ❑ List[]Map—Descriptloh:
<br /> FILE ADDRESS EHD USE ONLY
<br /> Street Street Name City Uh1t 1
<br /> 17 10 0 IA Vj
<br /> ❑Unit 2
<br /> 771) 1 �aM 0 Is .--Ac--r v1_1
<br /> Unita
<br /> 6.
<br /> "Unit 4
<br /> 7.
<br /> 8" Unit 5
<br /> C�
<br /> 10. I�J tJl �S/� � Unite•
<br /> Specific Date.Ran e f Informatlon Requested: From to
<br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES
<br /> 9,UNDERCROUND T (UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACIUTYNEHICLE
<br /> OTHER CLEANUP, I (N4N•LOP) ❑HOuSQia ABATEMENT WASTE TIRE
<br /> UNDERGROUND F (MONfTORINGIREMOVAL) Q FOOD FACILITY DAIRY
<br /> AsoVEGROUND ❑CHicKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT
<br /> HAZARDOUS WA E ous MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARO/CHEMICALTOILETS
<br /> SLTIERM PERNTTfIr F AGILITY ❑PDOUSPA ❑LAND USE APPUCATION SM
<br /> TATTOO18DDY PI1 RING ICON FUUNTIRESPONSE RECORDS ❑OTHER(PLEASE SPECtFY)
<br /> WELL AND SEPIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW, MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS)
<br /> 1. List up to lemaj dresses In the space above. Select the type(s)of files from the list above by cheaking the appropriate
<br /> box(es). At�a t one file type MUST be selected. Fax to(209)464-0138 Qr mail to the address indicated above, Addreaa
<br /> ranges will ri t e 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 nc tifythe applicant if any EHD files exist An appointment for review will be confirmed approximately ten(10)
<br /> days after ' e t of application, The files will be held for a maximum of five business days for review. Appointments
<br /> should be sG�e duled acz=ordingly.
<br /> 3. A file that Is lvely being worked on by EHD staff may not be immediately available for review, A new application may be
<br /> submttted w a i the file Is available.
<br /> 4. Arty file not r t irned in the same condition as released will be reorganized by EHD staff at the ex ense of the aRII
<br /> Future file re l ws by the same applicant may require a$125 deposit prior to review. f.3OXE FAUSEoNC1ry
<br /> ""..."--• .•.,. •,,.. . .. .,• ..r,,:•. .' ea". ,c <. ^.o..�,r fr,... :,}..ani, w' '' ' 'i "'Fry"-'-f} ;�U'�.1:+ ir4;: ;�='..
<br /> ,.,,.i r.....r•.. ... .... , .1{P., .-. {. ,.r.. . .r,.,: ,. •,„u.. .'..'..•...,,...: 'K.w :5,j7_ .:N.'ri�� - ::fin...�;: .5.. '.�1':•y",'':`R. '$;C'^,1?^ :'ri:'., •5'r'
<br /> eb'y,..r ,. ..r..,<a. .x- r1 ,�:. ';:;'s �:�;`•, ;'i-:�Isy:;..,..,,;,, ,t,.. r:' .',;,...
<br /> :•t,. '-,':r,_.I ..Fr. w4�.. .; ':1.'•�'^]::�1'+ - %`:NI'•:: '.k� t. .N V f'• _ =�.
<br /> :l. :�c'rrr.',,'L>i�r'''�'7: •I'•T r.1. r^. >.. I, '.%"' 11•wr�,r5i.•„ ,,1. •.�'_,.
<br /> ,_ .._....__::.,-. ,..: _...,. . .. 'o. ..._.,.__.-,..�....... •..: .e:•:'.r. �.. .ws .rx: - 1C -,;;rr rs. - - fru+_.:y..,}::::.;,• ,.L,.
<br /> ;�.:`' r• '.^.l_.N'....p,.;.....::.:':LL'w .. .. ..L'C:.`- ..l' - J.. :yJ� � iF. -!':'_':,:"'�:=• ..I.L :.r_'. ..L.. tir-'._V...-�,-�,
<br /> •-'•� i�...,_..d:��...l,.y _ .:4:: sr'=x;,��.. !" ..:.',�r;,,y,',,,�$:1�'s,,: .rrasmG. _`.�C.Sy ry.. ':In_ :4�•e�.-,.-f.:_ - !v''..4 .,--,�I_
<br /> :.—..1..�.:.-?r-+.--'."0'•�l_.. , .-.'a'I.� .., n..•- u.•/l�.'_��-•+�1...:11L__...:.,:.:::.�'_ ::T.., .•f.1.�f:.^ _ ,�:�.+:.Y'_ _
<br /> ,,.,G--^' _.'...-:,...J•r... ... .:1...}:. e . ,.:•L.M _,. :...._..,..s.. 1.,.Y,....r!'.it" ':_:.Sr' .,J:.1. _":_r'c iiT•('l!�J - �'J::�'.-.�.-,1{.. - - •I_s�.:�i':;T.,i�.' _
<br /> v1�r
<br /> .•;..,.. ... . -^,�':m,='.,'�1 r..r:..:;;" - �.{r...,::lc.;.!, a'X'•-a a�G. +.rlr?„ '''ri -_ �-,- ...r''; ,..:;^ '.65_.,.;,:
<br /> 1. _ .. ,... .: I�.,.....r, . ..._v. ,,.C ._F4.!,_ a tY,.. _ .i Y,• — ,^;r_i �;`..- 'w yrx, Y:
<br /> PAe•;�p1 f1lifiatil
<br /> EHO 48-06
<br /> Received Tim,Ie Apr. 15. 2014 1 : 16PM No. 5793
<br />
|