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u i r uor cu I o lulu (I-AX) P.001/001 <br /> W(E*IVED EHD LOG NUMBER <br /> ,n SAN •10AQUIN COUNTY <br /> JAN 0 8 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIR0NMENTALt one: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov_org/ehd <br /> PERMITISERAlICFS <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:. Rebecca Natal BUSINESS/AGENCY: AdVan . -d GeOFnVjrOnM ental <br /> ADDRESS: _837 Shaw Road CITY/STATE/ZIP: Stockton I CA 19521 <br /> PHONE(1): (209) 467-1006 PHONE(2):_(209) 623-7200 FACSIMILE: (209) 467-1918 <br /> TENTATIVE'APPOINTMENT DATE: #Jan Time: <br /> (Please allow 10 business days from d to of application submittal-'Tentative only-must be coMrmod) <br /> ❑ CHECK BOX TO EXPEDITE �$125�rEE(CA�SHK Y)- QUEST PROCESSED IN 3 SLJSINE.G DAYS <br /> SIGNATURE OF APPLICANT /Re/A— <br /> DATE f <br /> Electronic Information: ❑ List❑ Map—Description <br /> FILE ADDRESS EHD USE ONLY <br /> Street# street Name City <br /> Unit 1 <br /> 1 4236 S State Rt 99 E Frontage Rd Stockton <br /> 4236 Highway 99 or S Hwy99 Stockton i unite <br /> 3. I <br /> 4520 Highway hwa 99 T.- <br /> tHZ "5 <br /> 4 9 Clark Dr �- 1�eJ�us e;v� �� u Ica 4% <br /> 8. Unit 4 <br /> 7. <br /> El 8. <br /> Unit S <br /> 9. <br /> 10. <br /> p Unit 6 <br /> Specific Date Range of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> (]UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING AaATEMENT ❑SOLID WASTE FACILITYNEHiui: <br /> x❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY Q WASTE TIRE <br /> �UMERGROUNDTANK(MONITORINGIREMOVAL) ❑DOG KENNEL x❑DAIRY <br /> l� F�(z5 <br /> ❑x HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑x TIERED PERMnED FACILITY ❑MOTELIHOTEL ❑PUMPERTRUCK/YARDICHEWCALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA Q LAND USEAPPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS []OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAY$) <br /> 1. Ltd up to ten addresses In the space above. Select the typa(.$)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091484-0138 or mail to the address Indicated ab-ovi Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Appllcatlorm received after <br /> 3:00 pm will be processed the next buslnese day. <br /> 2. The EHD will notify the applicant If any EHD tlles 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 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 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. <br /> F".HO U96 ONLY <br /> I- kL WO-1I; il4 I-1 20 K-1 c1h F-67. W- ee V� . <br /> Lam,, 7r- "i e i -w S I h0 H" <br /> WA1u.i Lz r fop �. (),��t p tir��_� (Ate 1 L y <br /> 111D 4a-N 1'�Jv�lIQol (�� t�{ 1`►�P I t�FOf L� R�.r qi. C f zq.,to e 'ax.)( <br /> Received Time Jan. 8. 2015 10 :03AM No- 7865 1 <br />