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REECEI V EI.JSAN JOAQUIN COUNTY <br /> RUSH EHD LOG NUMBER <br /> • MAR 0 9 2011` ENVIRONMENTAL HEALTH DEPARTMENT �� <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> t' WIftONKI AL HEALTH <br /> PEAMIT/SEMICEI PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 611.1- Y/cK BUSINESS/AGENCY: t W2AV tf- <br /> ADDRESS: X3 0 c24 GF_ GWvIfc�, , aI7T — CITYISTATEIZIP: .5AW%P. WJ70,� <br /> PHONE(1): `Alo 3`4rlI �:2aO PHONE(2): q/,4 4g,z 72�79/ FACSIMILE: 9/( 56// �a�Z <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 /> Q,�CHECK BOX TO EXPEDITE REQUEST-$)30 FEE OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN SS DA _1/%Y <br /> SIG ATURE OF APPLICANT DATE O J��6 �J` <br /> Electronic Information: E] List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ./ ❑Unit 1 3f l?J <br /> a 1 c. lil/L EY tJ bt7/ ,4/9 i ) �5 Irs�eLM <br /> f z. i�iJ sLr. Nsr�(Jarrr t <br /> }}� � RPt✓ umtz LUI`I <br /> 3. 0 U �a �IIIJ(S� �1« � 7 Wb}7 14fYt <br /> 4' UUnit3 <br /> 5- kh-IPA OP <br /> • 6. Lk,4jCnL)61,Ic ;I it r d us( <br /> T. ti�G 5N/D EIE lad'a/t' LdTId rrf� fl tuvw �p l <br /> s 51 <br /> nit 5 <br /> 9. <br /> Specific Date Range of information Requested: From to rnl n�wi wn <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT [D WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH)DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE 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(2091464-0138 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 END 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$130 deposit prior to review. *"BOXED AREA-EHD USE ONLY' <br /> 7 -4— 7 7 7 _ T U7 Lo-4- 90 , <br /> L7 Records provided by Staff-PPR Complete. <br /> /Staff Name: 1 <br /> EHD 4846 'I <br />