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P. 00 <br /> 00 1 <br /> 1 -2008(THU) 13: 29 EHD LOG NUMBER <br /> ■;SAETPE-RECEIVED SAN JOAQUIN COUNTY <br /> i RECEIVED <br /> CItlE® / <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> AUG 2 6 2013Telaphone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PPAWTIAPAPPLICANT; S-f-etle- /` I /� BUSINESS/AGENCY: <br /> ADDRESS: lff(-7 'LL Ulf CITYISTATEIZIP: <br /> r n c <br /> PHONE(1): JOf— TQC-G6�Y PHONE (2):�© — olFACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of appIICAUon submittal-'Tonotive on y-must be confinnadl <br /> ❑ CHECK SOxTO EXPEDITE REQUEST- 125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU NESS DAYS <br /> SIGNATURE OF APPLICANT —• r DATE g <br /> 5 <br /> Electronic Information: ❑ List ap—Description: 2 U ` S <br /> FILE ADDRESS EHD USE!ONLY <br /> Street Stroot Namc CityUnit1 <br /> 1. 3 iiC'_a1-lto,f/ av¢D S z5�t/ <br /> 2. Unit2 �) <br /> 3. <br /> 4, 0 Unit <br /> S. <br /> 6. ~� l (J _ Unit4 <br /> 7. <br /> 8. <br /> units <br /> 9. <br /> 10. ❑ units <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILIIYNEHICLE <br /> ❑OTHER CLEANUP SITE(NoN•LOP) ❑HOUSING ABATEMENT ❑WA5fETIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑F000 FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DDG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARODUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETs <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE 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, Soloct the type(s) of files from the list above by checking the appropriate <br /> box(es). At least one file typo MUST be selected, Fax to =91 914640138 or mail to the address Indicatedabove. Address <br /> ranges will not be accepted-for additional assistance with filo addresses,contact the EHD. Applications rE ved after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximatoly ton (10) <br /> days after receipt of application. The files will be hold for a maximum 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 roviow. A now application may be <br /> submitted when the filo is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at tho expense of the applicant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. �0&E-D R,iEI�FzNDL'S 4y1y <br /> •�'� Polh;�:1 �a� g' ��SMt+,�. Com , „ �Yd6 <br /> ND;Recor_cl.s�pKovitled by`n"Staff P�PRComPlete�ei�N mom, ,'�r�t.,: rl:�r.+�'' .�rc .�1 � "'p �tx <br /> tReci'ived Tlme Aug, 26. 2013 1 :42AM No. 3919 `lu" <br />