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�■ 08/08/2014 13:09 805239930" SIERRA DELTA CON"11-T PAGE 01/01 <br /> I ■ <br /> ■ <br /> I ■ , <br /> I� CEEIVED EHD LOG NUMBER <br /> I ■ DATla� SAN .IOAQUiN COUNTYT ENVIRONMENTAL HEALTH DEP �11 O <br /> AUG 0 8 2014 Hazelton Avenue Stockton, 0 5 23 <br /> 1868 East H , <br /> Telephone:.(209)460420 Fax: (209)464-0136 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> ..PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: S BUSINESSIAGENCY: <br /> ADDRESS: Sj "U'twA,,,4,--,,k CITYISTATE/ZIP: <br /> PHONE(1): - 23`�-`��$'p PHONE(2), FACSIMILE: �S' 9 3D5 <br /> TENTATIVE'APPOINTMENT DATE:se Time: <br /> (Pleaallow 10 business days from date of application submittal-'Tentotive only-must be corihnned) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE( OR ECK Y)-REQUEST PROCESSED IN 3 7WW�� <br /> SIGNATURE OF APPLICANTliDATEElectronle Information: ❑Hat❑Map—Desc n: <br /> FILE ADDRESS EMD USY <br /> get 0 Street Name City Unit 1 <br /> 1. G'�G ��tG <br /> 2./ ❑Unit 2 <br /> Id <br /> � (1`, e(7J, LUG/�� i Unit9 <br /> 5. <br /> 6. Unit 4, <br /> 7. <br /> 8. Unit 5 <br /> 9. c2 <br /> 10. - Unit 6 <br /> Specific Date Range of information Requested: From VY to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(Up CLEANUP SiM(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILiiYNEHICLE <br /> OTHER , <br /> CLEANUP SITE(NON-LOP) ❑HOUSING AfIATEMENT WASTE TIRE <br /> �enNDERGRDUND TANK(MONiTORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> Z <br /> 1]90VEGROUNDTANK CHICKEN RANCIV DOG KENNEL C]WAMVATER TREATMENT PLANT <br /> AZARDOUS WASTEIHA7ARDOUS MATERIALS ElMOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILiTi' ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTowBODY PIERCING ❑COMPLAINTIRESPON9E RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1, LIO up-to Ign address In the apace above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to(20914Bd-0138 or mail to a address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with filo eddresgos,contact the EHD. Applications received 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 approximately ton(10) <br /> days after mcelpt of application. The flies will be held 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 review. A new application may be <br /> submitted when the flle Is available. <br /> 4. Any fll&not retumed 1n the same condition as relaesed will be reorganized by END staff at the ex ansa of the ap lip cant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> i <br /> r. � J�'L:r6: <br /> Received Time Aug. 8. 2014�1 : iR, No, 6775 °'412 <br />