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02/02429e 12:33 503--726-5995 FEDEX OFFICE 5303 PAGE 01 <br /> t <br /> �■■ DATFEC E IV E Id" 6 F_HD LOG NUMBER <br /> :■ SAN JOAQUIN COUNTY <br /> FEB 02 2015 ENVIRONMENTAL HEALTH DEPARTMENT �n <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAT0RkFine: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: :�6,GY1 BUSINESSIAGENCY: EBI DMS .1" <br /> ADDRESS: SE PjtfSV UEhVf2. CITYISTATEIZIP:�/� 4qua <br /> PHONE(1): 5( 094-2,10- PHONE (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 arrangea appointment date and time to review the requested records. <br /> ElCHECK BOX TO EXPEDITE R UEST- 1 FE�ASH CHECK ONLY) REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN' DATE 02 -OZ—15 <br /> IF I V IF <br /> Electronic Information: ❑ List❑ MAP-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Namea City 0 Unll 1 <br /> [44. <br /> vd VAI ico Roosa vTraf,v -0 unit 2 <br /> 1-s-i� E]1, <br /> 3 <br /> OUnit 4 <br /> 7. <br /> 9. <br /> 10. <br /> ©Unit 0 <br /> Specific Date Range of Irdormatlon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Dg UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El MEDICAL 50ICAL WASTE FACILITY W SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK El CHICKEN RANCH/DOG KENNEL JE WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE(HAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTo0IB0DY PIERCING g COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:00Pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 Or mall to the address indica ed 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 END 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. -"'QOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. staff Nama: <br /> Received Time Feb. 2. 2015 12 : 33PM No. 8002 <br />