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r-: Pnge 2 of 2 2014-04-30 14:54:22 (GMT) 1aosao2a021 From: Myron Olson
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<br />DATER EHD LOG NUMSE
<br />_ RECEIVED SAt� ,�C1AQUlN COUNTY `� `
<br />R . 0 2014 ENVIRONMENTAL HEALTH DEP`ARrMENT
<br />AP 3 8 -
<br />186 East Hazt?Itorl Avenue, Stockton, CA 95205 6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd
<br />EWFIONMENTAL HEALTvi a .c Yattc''kv.i 6 l ikil''"ice I>.' .
<br />PERMMSERVIC gLIC RECORDS RELEASE APPLICATION
<br />APPLICANT:lYxs l BUSINEWAGENCY: ff4yty` U Co rm"
<br />ADDRESS: �' ( _ T _ CITYISTATEIZIP: a 23Z
<br />RHONE (1): Sl D 5-�/-MS_ZPRONE (2):. FACSIMILEJ�- .
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<br />TENTATIVE* APPOINTMENT DATE: Time: C r�
<br />(Please. allow 10 business days from date 6f application submittal -'Tentative only- must be confirmed) C.il
<br />CHECK BOX TQ EXPEDITE REQUEST $125 FEE (CASH C CHECK ONLY)- REClUESi PROCESSED IN 33 rBUSINESS PAYS
<br />SIGNATURE OF APPLICANT Z i1�A� -- DATE 1/
<br />Electronic -information., [! List 0 Map — Description:
<br />FILE ADDRESSEHD
<br />USE ONLY
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<br />Unit 5
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<br />Speci€tc Date.Range of Information Requested: From to
<br />ENVIRONMENTAL HEALTH DEPARTMENT FILES
<br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) Lr -yl MEDICAL WASTE FACILITY' ® SOLID WASTE FACRITYJVENICLE
<br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE
<br />FA VNDERC+ROVND TANK (MONITQRINGIREMOVAL) ❑ FOOD FACILITY DAIRY
<br />ABOVEGROUND TANK ❑ CmCKEN RANCHI D06 KENNEL WASTEWATER TREATMENT PLANT
<br />ifAT,ARDOUS1NASTEIHAZARDOUSMATERIALS 0MOTELIHOTEL ❑PumPERTRUCmt
<br />WARDICHEcALTOILETS
<br />r3TIERED PERMITTED FACILITY ❑ POOLISPA [] LAND USE APPLICATION SITES
<br />FI TATroolsooy PIERCING-VICOMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY)
<br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 ANI7-5.00Pm (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 f20914644136 or mail to the address indicated above. Address
<br />ranges will not be aceeisted - far additional. assistance with file addresses, contact the END. Applicationsreceived after
<br />3:00 pm will be processed the. next business day.
<br />2. The E.HD will notify tate 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 />3. A fife that ls.a ctive.ty being worked on by EHD staff may not be, immediately available for review. A new application may be
<br />submitted when the file is available.
<br />4. Anyfile not returned in the same condition as released will be reorgat)lzed by EHD staff at t:he expense.of the a. plicant.
<br />Future file reviews by -ft same applicant.may require a 5123 deposit prior to review.fY
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<br />Received Time—Apr, 30, -•2014— 7,52AM—No. 592
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