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DATiSep. 22. 2015 2: 13PM <br /> • SAN JOAQUM COUNTY . No. 1911 10' 30NUMBER <br /> ' <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 ' <br /> OCT 14 ffglephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> RI!IQOKIAAEMI_HFAITH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SERIC ° <br /> APPLICANT: (,QUI. l(f1f1(C BUSINESS/AGENCY:S.TC6f,{A_N1 rltbliL 4 DOI� S <br /> ADDRESS: I�1L �• Y7 P 1fk1 !IVC _ CITY/STATEMIP: 2�C- <br /> PHONE(1): L ��� –�' S PHONE(2): FACSIMILE: LpGk- ZA6�j <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 data and time to review the requested records. <br /> ❑ CHECK BOXTO EXPEDITE REQUES�EE fOCHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_ /l(�'[ DATE ZI^ IS <br /> Electronic Information: ❑ List❑ Map–Description: <br /> FILE ADDRESS <br /> StreeE# Street Name Off, EHD USE ONLY <br /> 1. ZlG 0 Pl- ✓vi waxes wive. •Lv,), u.,er-1-cot <br /> 2. ?,(�)73 � N. lM am OnVr, StDU6-1an vc-v- �nKt <br /> 3. 313Lf 11"Ce �jteSpiLdsitz <br /> 4. 3220 F. lar cp_ 17(�vy/ S(ZUG?L0nV tjb"-1 >n <br /> rte, c, on vc, � vu�/j 14VwMF-tn b-Wks h 2H 111 9 <br /> B. X62 : W ce aWe� SPC�M^ Nrr- <br /> {�Unit 3 <br /> 7. Z�lo N. 7 DV I V� ®u it 4 <br /> S. ��PJS N . 7 ° ��1� Ulsf7a l 4 Y 11MM i -(4I cLa—coftj 0 St <br /> 9. 32,(P°I "17YYG[kLG{tu� I Ivy DcL1 Nor- ���/, <br /> 10. 31-7A_ '(a�GGhGU�Lr rJYIU� S�(b[ IL T d/ &IUnit5 <br /> Specific Dat5 Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Ej MEDICAL WASTE FACILITY SOLID WASTE FACILITYfVEHICLE <br /> R OTHER CLEANUP SITE(NON-LOP) ( HOUSING ABATEMENT WASTE TIRE <br /> Q'UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY DAIRY <br /> ABOVEGROUND TANK ®CHICKEN RANCH/DOG KENNEL .®WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL .®'PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPA 2 LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ®COMPLAINVRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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.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 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 at 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 /> P,;jc;1, Vt(e5 Vw(,6•Lm r G f-7.[k-7 !r' w.� 3a tai LvA c ,,k 1-71 Cle.N, <br /> 0-7 Www mL 2.733 TQ¢ o IrMI CO ).776 c A (0001-A tie`•^4f- <br /> 1A W Vitt (.Of 2--7SS . <br /> n o...... Ar ..rr..,;A—A Im. �'i fc uno n0.__r_a_ Staff Nama: <br /> Received Time=Sep. 22. 22015= 2: 09PM_No._9621 <br /> ERD 48-06 - 7N/15 <br />