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no 05/12/2015 10:59 2098330707 UPS STORE1860 AML PAGE 01/01 <br /> D <br /> vaIVED EHD.LOG NUMBER <br /> itSAN J OAQU IN COUNTY <br /> MAY 12 2015 -ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL HEATIA10ph6ne: (209)468-3420 Fax: (209)454-0138 Web: www.sjgov.org/ehd <br /> PERMITISERVICIEES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: C O�rt.�i- " 4tON <br /> ADDRESS: �_1 If�r k_a_ CITYISTATEIZIP: 1 <br /> PHONE(1): � -2(DZ,•-��'SC( 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 arrange an appointment date and time to review the requested records, <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street#.. Street Name City ®Unit 1 <br /> 25 <br /> 2. Unit 2 <br /> 3. � � <br /> 4. 2founit 3 <br /> 6. unit 4 <br /> 7. ��ai�eA f°I Aro ` . <br /> $, t7 [I Unit 5 <br /> 9. .1®I� <br /> 10. 0 Unit 6 <br /> Specific Date Range of Information Requested: From to' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0A N ERGRoumD TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> WER CLEANUP SITE(NON-LOP) F1 HOUSING ABATEMENT E]WASTE TIRE <br /> NDERGROUND TANK(MoN1TORm/REMOvAL) ❑FOOD FACILITY ❑DAIRY <br /> [ICBOVEGROUND TANK ❑CHICKEN RANCH/DDG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> RAZARDOUSWASTE/HAZARDOUS MATERIALS ❑MOTEL/HOTEL []PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 21flERED PERMITTED FACILITY ❑POOUSPA ❑LAND USEAPPUCATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RE:viEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space 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(209)464-0138 or mail 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 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. Appo intments <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$125 deposit prior to review. '`"'BOXED AREA-EHD USE:ONLY`** <br /> rodkek C& 6 (It Ilk) l( v a A CQ c2a 3 owe, a., <br /> LA-SI r—i te— Vyf I I 10 11 <br /> 0.Records provided by Staff-PPR Complete. Staff Nerve: <br /> can A8a6 4/28H4 <br /> Received Time May. 12. 2015 10:54AM No. 8709 <br />