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Mill Apr. 1. 2015 3: 06PM No, 0124 P. 1 <br /> M <br /> eM REGE#�/ED SAN .JOAQUIN COUNTY EHD LOG NUMBER <br /> lox APR O 12015 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 /> ENMRONMENTALHEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: wte BUSINESS/AGENCY: L�Mks Ln✓Irovime'J-t <br /> ADDRESS: 33 CITY/STATE/ZIP: UovA- <br /> f (;/s- Ir(' 'L( <br /> PHONE(1): S'IO—M7- 13 8 5-y.30.'IPHONE(2): FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> /t5EHECK BOX TO EXPEDITE REQUEST-$130 FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT___ DATE :5 -3 t' t 5 <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 unit <br /> 1. <br /> 1112> No s W Ra c acr i <br /> 2• I Or o w k^ooL J be h I� n1t2 <br /> 3. $' o i- �'(1 Lj P-a s4ATu <br /> 4. <br /> 5. <br /> Jb R4 <br /> 7. <br /> 9• Unit S <br /> 9. <br /> 10. ❑Unit e <br /> Specific Date Range of information Requeated: From ArIl to <br /> All <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICALWASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ,(OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ' DAIRY <br /> ABOVEGROUND TANK <br /> El RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE(HAzAROOUS MATERIALS ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATroo/BODY PIERCING RCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)484-0138 or mall 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 flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 END 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 /> 13 Records provided by Staff-PPR Complete. Staff Name; <br /> EHD 4E-08 00101114 <br /> Received Time Apr. 1. 2015 3: 15PM No. 8439 <br />