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f DATI�°P• 22, 215 2: 13PM No. 1911 EfP• 3Q NUMBER <br /> SAN JOAQUIN COUNTY <br /> RECENEDENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> OCT 14 2(fglephone: (209) 468-3420 Fax, (209)464-0138 Web: www.sjgov.org/ehd <br /> Fr,l1Il QhIAnPhjTAI 14FAITHPUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SER IC-c <br /> APPLICANT: Mum:H <br /> 11 f �1 ( A BUSINESS/AGENCY:( .a(,0U„ f1j I UbI(( LV00CS <br /> ADDRESS: /`1�( O G• Gt/J p�_U2 AleCITYISTATE2EP: ��,ZD <br /> PHONE (1): G2 LI&N-3 PHONE (2): FACSIMILE: qr,> - iAC�71 <br /> Please allow 19 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 REQUEST-$130 FE (C QR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � [ DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> �J- -V0 VVa , w 111/t <br /> 2• ZCJ 3 N- Wl GUY) Or S�UULhA 1 A161= �_U�nie 1 <br /> 3. 313L( L%tr Ce / }1k" S l(>i6y) (ovmdol.4 teSp,(sl�o ,It2 <br /> 4. 3n(o E. L441 66 oe( v& obyn �,unit 2H IOl✓ <br /> � �9 <br /> S. 3z5� �i LGLYI c, on Ufi S(ULfL{royl I4t»HP_t(3 Io-h-1 � <br /> 6. X62 aw ce- QW& Siv�k l� ivl r- ' <br /> {a]Unit 3 <br /> 7. N. lqdoa Or( VL' S17y-f --Tuo p nit4 <br /> s. jr�35 N . fin Vf�l -q ick w CWW trnti ly 3-`co,f1G1+ -(yp� yrt <br /> M <br /> �. -�rn�a�al.t� pri,� nh1,�DJY GW1GlAJ /� �nUY s'(t ULj�lyi lY 17'6nit5 <br /> Specific Date Range of Information Requested: Ron. to <br /> ENVIRONMENN7TAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) r=l MEDICAL WASTE FACILITY ]. SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ®HOUSING ABATEMENT WASTE TIRE <br /> •ryQ'UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY DAIRY <br /> rJ ABOVEGROUND TANK ®CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> '®HAZARDOUS WASTEIHAZARDOUs MATERIALS ❑MOTELIHOTEL .PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPA 2 LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ®COMPLANTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 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 fie 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 a maximum of five business days for review. Appointments <br /> F should be scheduled accordingly,. <br /> 4. Any fire 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 /> P77 w e. L.,�L2735 Tee �, o Iw,„� CO 1� 6 rwn�COt9 zl ove`,� e <br /> W W Vittr ?--77 S . <br /> n o........i.- .-rr..,:a...� <br /> 1)11 e4,�fc IMMM rQ""-'-`- Staff Name: <br /> Received Time=Sep. 22. _2015= 2: 09PM=No..9621 <br /> END 48-06 - 711/15 <br />