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0 E1012012014 10:57 FAX 4082581112 <br /> n� Z0001/0002■ <br /> ■ ■ <br /> ■■■ <br /> En K)ATGFFrr <br /> mPEIVED' SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> OCT 2 fl 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION ll <br /> APPLICANT: CC u v G v nti.�,\Q ti BUSINESS/AGENCY: C�� C6QA('\ C S�0 P S <br /> ADDRESS: a1�\ �\vrv� �OC� 1'�`/� CITY/STATE/ZIP: SC(�\ )�S� (A 9S13 -1 <br /> PHONE (1): qG� ' Oto 7j�'�V PHONE (2): -1I I q FACSIMILE: X015 5 -111 � <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to aUE <br /> -anen app I tment to and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQ0 FEE( H OR CK ONLY)-REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT �t DATE 101. 0 � U 1 q <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City _ ❑ Unit 1 <br /> 1. 3gAo Mu,r\ S' -ko(Aon 1C- <br /> Unit 24. <br /> if <br /> 3. <br /> ,M-Unit 3 <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7. <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> EEr�NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY <br /> ❑OTHER CLEANUP SITE NON-LOP SOLID WASTE FACILITYNEHICLE <br /> �r�, ( ) HOUSING ABATEMENT E]WASTE TIRE <br /> LJ UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑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)464-0138 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 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$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 08!01114 <br /> Received Time Oct. 20. 2014 10:48AM No, 7362 <br />