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i <br /> 0411012015 13:1.5 TAX) P.0011001 <br /> r. <br /> ■� EHDLOGNUMaER <br /> ReCEIVED <br /> SAN .10AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR 10 2015 9868 East Hazelton Avenue, Stookton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> HERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICAT101F I I E Crsn <br /> APPLICANT: William Littl _ BUSINESS/AGENCY: Adymninad n AoEnylronmental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP: Storldon / CA /95215 <br /> PHONE(1): 209-467-1006 PHONE(2): .209- FACSIMILE: 209-467-1118 <br /> -� <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submWAI-4rentetive only.must be confirmed) <br /> 0 <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$12 F E(CASH OR� � REQUEST PROCESSED IN 3 BUSI,,NE//SS DAYS <br /> SIGNATURE OF APPLICANT W ) , DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRES$ EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> i' <br /> East Louise Ame Lathrop <br /> /365 East LoUise Ave is unit 2 <br /> D'Argy Parkway Lathrop � LI <br /> /O <br /> UnIt3 <br /> g, Unit 4 <br /> 7. <br /> $ :Unit 6 <br /> 10. D.Unit 6 <br /> Specific Date Ranee of Information Requested: From all to / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> x❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> R]OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY O WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑•CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY [E]COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to tan addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(ee). At least one file type MUST be selected. Fax to(2061464-0138 or mail to the address Indlcated above._ Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed-the next business day. <br /> 2. The EHD will notify the applicant If any EHD tiles exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 EHD 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 some 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. <br /> EHO USE ONLY <br /> vwn na.oa E/ili i <br /> Received Time Apr, 10. 2015 1 : 12PM No. 8510 <br />