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I ■ <br /> ■ 3:54 a.m. 08-05-2015 1 /1 <br /> IMM �''� EHD LOG NUMBER <br /> �■ REG&VED SAN JOAQUIN COUNTY <br /> IN ENVIRONMENTAL. HEALTH DEPARTMENT <br /> AUG 052015 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd - <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 13 z! C_00 i BUSINESS/AGENCY: Gondar- IEcti TA JCcrl. <br /> ADDRESS: I R s rrA j W6&S°r Cr. ,S7"e . CiTY/STATE/ZIP: <br /> PHONE (1): �2a�)q 39- ,/ Z I PHONE (2): � q)6O I`8�6 Z FACSIMILE: 4 91M—05-.38 <br /> i T <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-$130 FEE(CASH OR 'HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Aw_ DATE 815-115 <br /> Electronic Information: ❑ List❑ Map-Description: 4�,�I S5-18 04?- _____ <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> 1/6 <br /> Street# Street Name City <br /> (.1 a2�7`nh . Z SToc-lcTan I (;-t <br /> 2. co,v Xa-C.� ❑Unit 1 <br /> �( 3. ❑ Unit 2 <br /> 4. <br /> S.P 5. <br /> ❑Unit 3 <br /> 7. <br /> J]'Unit 4 <br /> 8. ❑SITE MITIGATION <br /> 9. <br /> 10. I ❑Unit 5 <br /> Specific Date Range of Information Requested: From 1 S to t 7i0 <br /> IT <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SiTE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYiVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONiTORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> A6OVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOT LJ-HOTEL ❑PUMPER TRUCKiYARD/CHEMICAL TOILETS <br /> F1 TIERED PERMITTED FACILITY ❑ USPA ❑LAND USE APPLICATION SITES <br /> ElTATTOOIBODY PIERCING CoM PLAiNTIRESPONSE 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)464-0136 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`appllcant may require a$130 deposit prior to review. -BOXED -EHD USE ONLY'" <br /> �'�-'�aa�( C-1..��-• 1'�-,;,' �0," I i� �-���z�aku-� '' . t���ia��� (.�'�.�I ' z, L iJ L^��`• }✓� ��-�� �Ui �.; 5 7�ci� v'l�t c <br /> i o o Ave, <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD"-06 71V15 <br /> Received Time Aub• 5. 2015 11 : 14AM No, 9262 <br />