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A �� ED,�`��✓',®�� REVIsm- <br /> ;7' 71-1741(_ :��Ny;,.a r>.�,:�.ylv?FI.=.moi-. <br /> SAN NTY - <br /> ,JUL 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> den 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL H�LT►�I hone: (209)468-3420 Fax: (209)464-0138 Web: vwvw.sjgov.org/eh� <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> %4H <br /> APPLICANT:���,t� f+�I t�-,Itl�S ' - BUSINESS/AGENCY: Fi �- <br /> ADDRESS: CITY/STATE/ZIP: WaAlLA- CV4_,z -, C.f4 9'4S"1- <br /> PHONE(1): 0j `i t' j PHONE(2): 6) S"`�. ?.GS. 14-1 CG-? FACSIMILE: 61 L5 . c74 G;. 9 ctC,'Sr <br /> '0i v�' Please allow 10 business days from date of application submittal for the reco t b vailable. '1! V <br /> Staff will contact you to arrange an appointment date and time to review the ell records. <br /> 11"CZ <br /> CHECK BOX TO EXPEDITE REQUEST_$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN,3 BUSINESS DAYS <br /> vivi:r�iTU0E QC ADDI r11Ak1:f-1'\ i <br /> IElectronic Information: E] List ElMap-Description: 'T .f`i , 7 i ; / , 1, ? ' 711-! CL' /7-/ <br /> FILE ADDRESS EHD USE O"LY <br /> Street# Street Name Gi u� City _2. i Lo C*-k.._Cj Ca.�r � z, c.t��a , i K � <br /> 3. <br /> 4. J.2(;' ] 31, . aoc' .S [2/Un it 3 <br /> C> <br /> /6. ; ❑Unit 4 <br /> 7. <br /> X. `1. �., �� "I=.2, 9 © �Ot(1 Ti ❑Unit <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> U'UN ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> ^� ER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> L<u ERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCK[YARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING �COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up 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(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. 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$125 deposit prior to review. ''BOXED AREA-EHD USE ONLY'' <br /> r0-Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 4/28114 <br />