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e : 2 of 2 09/9/2015 C 9 AM TO : 12094640138 FF--' : Genevieve Enriquez <br /> t-i�?F #5104349200 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> gED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> SEP 0 9 2-Offelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> P'e1.T43AG9d`e t�iPii-AOTA! v,�,t,��� PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SENT ES <br /> APPLICANT: C Nil* Wbl BUSINESS/AGENCY: <br /> ADDRESS: y_Iob CITY/STATE/ZIP: IDNVI�M QN <br /> PHONE (1): � 4blk-' 'kA 6)�\'1j03 PHONE (2): FACSIMILE:(Sk% <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST/' 5 FE H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ()1 DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 3 _ l <br /> 4. pec4t�"k I F l(t CD bel El'u It 3 <br /> 5. <br /> - 6 -I®-1 ❑'Unit 4 <br /> 7. <br /> 8 ❑ Unit 5 <br /> 9. <br /> _ J <br /> 10. Uri1ts <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY/VERCLE <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> Q UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> SABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> Q HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING Q 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(209)464-0138 or mail to the address indicated 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 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. Appoiotments <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. '.BjdAE2E 'zMD t�S__E QCT <br /> F i � r w' ,+.�, �r is z:Yy q/� .e+'!-i (+ (til +q t� - S,v. __..3.zL�:{�; .y i!a,.li!(�' r•"—r— —�— - _ <br /> ..:-, "•,j -'���'`—_� -_c—=:��1—`�s m-"t`, i lix�A:-'7xN�. !f j Int - �l° ��a-. —. Sa''�''-1�:�+��-+"�IL'.+N t�}�.,fl�i���_x�,��. <br /> - � h9' �i'cliif., <br /> ��ryI E�t7 lrk� 4� r I ,t �} u I� — t II �nF"-• 1j 1 \ f� <br /> q:_lec �cis`proi'cleE Stiff P , <br /> m f2fiC�ofete ,staff,�famQ <br /> p,, - <br /> 8/4112 <br /> EHD 48-06 <br /> Received Time Sep. 9. 2015 9 : 19AM No. 9523 <br />