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GENt9 ® 46 0 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 19 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 11 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTALHEALLWphone: (209)468-3420 Fax: (209)464-0138 Web: WWW.sjgov.orglehd 110 <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:__! <br /> PPLICANT: ;-� p-� <br /> PM <br /> 0 `�� 1'� ('� ei.l�Z BUSINESSIAGENCY: l�`r'Uk.y( <br /> ADDRESS: P --OX ` Fid� CITY/STATE/ZIP:_S-t b7_1C,70-S 'A r�'!a®j <br /> PHONE(1): W1 GO(? PHONE (2): ate q3-X- OnC)b FACSIMILE: 10-C Cf,61`7- 351,? <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 REQU T-$125 FE ASH OR HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: ❑ List❑ Map- escription: <br /> FILE ADDRESS EHD Use ONLY <br /> Street# Street Name city `i Unit1 <br /> hl 00 1 <br /> 2v 2. <br /> �/Uit 2 <br /> 3. )nT L] �Y <br /> 4' � Unit� <br /> 5. <br /> 6' '4it <br /> 7. <br /> 8. <br /> /Unit 5 <br /> 9. <br /> 10. (UD Unit 6.1 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALT DEPARTMENT FILES . <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) E MEDICAL WASTE FACILITY SOLID WASTE FACILRyAFEHICLEE�� �/� <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT - WASTETIRE 4 {'{tQ'S2/fir � � <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)p� FOOD FACILITY DAIRY �J 3--3 y <br /> ABOVEGROUNDTANK <, .CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS E MOTELIHOTEL PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITYdk E POOUSPA LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING E COMPLAINT/RESPONSE RECORDS OTHER(PLEASE SPECIFY) <br /> WELLAND 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-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. 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 app i nt may require a$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> 2S J19 'n 1 <br /> rd A 10 ( 1`Cet/7 <br /> leg <br /> - 3 1" cm f 6 z 1 <br /> D e © .. lOih a i. <br /> ❑ Records provid d by Staff-PPR Complete. staff Name: <br /> EHO 48-D6 SW12 <br />