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28 -2013 11:36AM Enviro Assess 8776235493 page 1 <br />EHD LOG NUMBER <br />® SAN JOA UIN COUNTY <br />AEMIVED <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />OCT 2 S 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />Fz� 1i �v <br />r <br />ADDRESS: /�. �, CITYISTATEIZIP: rapamrs !W:2� <br />PHONE(1): �Ii� Q ���- Q$O PHONE (2): $ •4 9-•683RFA"C'"SI�MILE: 97 • J'�� <br />TENTATIVE* APPOINTMENT DATE: PLS. C41,1— iF recoi'C� F®r�io� ime: <br />(Please allow 1D business days from date of application submittal - *Tenfative only- must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT - DATE &f Ag- -1013 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS END USE ONLY <br />Street # I Street Name <br />CA <br />City <br />No <br />110. I 1 U unit o <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 FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />MilUNDERGROUND TANK (MONITORINWREMOVAL) F1FOOD FACILITY ❑ DAIRY <br />® ABOVEGROUND TANK FICHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT 1 <br />® HAZARDOUS WASTEMAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDIGHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING Ni' COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR R". Ew: MONDAY -FRIDAY 8:00 AM•5:00PM (EXCLUDING HOLIDAYS) <br />1. List un 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 (2091464-0138 or mail to the address Indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after <br />3:DO 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 ten (1 D) <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 />3. A file that is actively being worked on by END staff may not be immediately available for review. A new application may be <br />submitted when the file Is available. <br />4. Any file not returned in the .same condition as released will be reorganized by EHD staff at the expense of theapplicant <br />Future file reviews by the same applicant may require a $125 deposit prior to review. _ <br />I (� <br />litl <br />i ��f�r g , ,n U 3 i' 3#• 2 IP • 1 #�1 � <br />9/4112 <br />Received Time M. N. 2013 12:48PM No. 4368 <br />