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c RECEIVED tHj2.LUU NUMBER <br /> 11 SAN JOAQUIN COUNTY <br /> F i ,/7 <br /> ,ECEIVED E411ONMENTAL HEALTH DEPART NT1868 East Hazelton <br /> 32 <br /> APR 18 .2014 Telephone: (20 9) 468-3420 Fax: (209 )464-0138 Webenue, Stockton, CA : MMM <br /> M/IRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /.�/LL V1C BUSINESS/AGENCY: fC2q�,�f50G/�JTE� <br /> ADDRESS: V VQ 441100�FF 6VOV9 ' SU/Xe A=- CITY/STATE/ZIP: <br /> PHONE (1): 7/6 ani vV 00 PHONE (2): �J/� ,."?F r7�9�_ FACSIMILE: <br /> TENTAT/VE`APPOINTMENT DATE: Time: <br /> . (Please allow 10 business days from date offAapplicatli n submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST,S,125 f ( SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN S DA <br /> SIGNATURE OF APPLICANT //�cr�'f( DATE <br /> Electronic Information: ❑ List❑ Map–Description: <br /> — FILE ADDRESS EHD USE ONLY <br /> Street It Street Name City ❑Unit <br /> 1 <br /> NDS ❑unit 2 <br /> 3. <br /> 4. <br /> ------ '— ErUnit3 <br /> 5. - --- -- -- — <br /> (70 <br /> B. --- — <br /> 9.10.- ❑Unit 5 <br /> ❑Unit s <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE I)e <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILRY L1 WASTE TIRE 3 <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY LM <br /> AL <br /> AZARDOUS WASTE GENERATOR CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT M <br /> TIERED PERMITTED FACILITY ❑MOTeUHOTEL lj PUMPER TRUCKNARDICHEMICAL TOILETS - <br /> ❑TATTOOISODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM (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 f2O91464-0138 or mall to the address indlcated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the 12H10. 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 flies 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 applicant may require a$125 deposit prior to review, <br /> J-36 . t'92-/3 $-CbWD '6 In ft e LXST qe ' 85b M eo. <br /> -6c:, kct4p— Ac SSb <br /> eec a se me, p I, , - P1V7_ h6828 <br /> aMlta <br />