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-o uct. Ib. 2uih 4: hirM No. 0328 P 1 <br /> FSI$ <br /> IISRECEWED. ` EHD LOG NUMBER <br /> iiaAtCEIVED SAN JOAQUIN COUNTY <br /> °Ise ENVIRONMENTAL HEALTH DEPARTMENT rL <br /> OCT 19 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web,v,Wvv.sjgov.orglehd , <br /> ENVIRONMENTAL HEALTH <br /> PUBLIC EtECC3RfJ3 RELEASE APPLICATION <br /> DCD6RIT/ +n-, _ <br /> APPLIC`IANT: C.4gl>oa f}-I'G BUSINESS/AGENCY: <br /> ADDRESS: 16o.✓E PALM 4VC , Sul7'62o16 CITY/STATEIZIP: WtoDCts' r- cA 9S3S/ <br /> PHONE(1): 2.09 579 ;ZA�V-( PHONE(2): FACSIMILE: Zoq <br /> Please allow 10 business days from date of application submittal forthe records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records, <br /> ❑CHECK BOXTO EXPEDITE REQUEST 13 FEE(C H CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE /fl / S <br /> Electronic Information: ❑List❑ Map-Descri tion: <br /> FILE ADDRESS <br /> Street if Street Name City EHD USE ONLY <br /> 1• 31 �Pdi✓G✓/d •etJC- 57oc✓c7o� 4W N^""M'GOtf.�Cw—l� <br /> 2. <br /> Unit 7 <br /> 3. - ,,yy i4)[L (At ❑ lt Un2 <br /> 4. �b"^ 0 Unit21-1 <br /> 6. <br /> nl[3 <br /> 7. <br /> // it <br /> n4 <br /> B• /SITE MITIGATION <br /> 9. <br /> 10. <br /> ❑Unlf 5 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 10/L NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑'EITHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WAS-,E TIRE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑Fool)FACILITY ❑DAIRY <br /> [/ZA90VEGROOND TANK ❑CHICKEN RANCH[DOG KENNEL El WASTEWATER TREATMENT PLANT <br /> R HIERERDOUS WASTE]HAZARDOUS MATERIALS E]MOTELMOTEL El PUMPER TRUCKIYARD[CHEMICALTOILETS <br /> D PERMITTED FACILITY El DLISPA r]LAND USE APPLICATION SITES <br /> F]TATTOOISODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 500 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List uD 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(Z09)464-013B or mall 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 EHD records, please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant If any 8HD 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 condltlon 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. 4"BOXED AREA-EHD USE ONLY°' <br /> / tv� v-aek 1top v(- mow, kepart earl RM,. tor. WA taw at <br /> •�{/M IW T f7o t U�' 1 IrF 1••U Or. <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time—Oct, 16. -2015— 4:49PM—No. 9811 ,,HS <br />