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::10/20/2014 10:57 FAX 408258111.2Q0001/0002 <br /> �■AT � EHD L G N <br /> �� C E�"V SAN JOAQUIN COUNTY O UMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 2 0 2014 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH v, <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION 1 <br /> APPLICANT: �� v Go nti.c�\� ti BUSINESS/AGENCY: (_�.1 L.6Q� ac,\ C-S (Aee <br /> ADDRESS: �1 \ �`U rv� �� �J� CITY/STATE/ZIP: SQA �O SR (A 9S0 -7I <br /> PHONE(1): qG� 0�; 7j �V PHONE (2): �0� �S� I l I �j FACSIMILE: 43S�S Il I <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to ar-ange an app Ten t to and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQ EST- 1 OFEE( OR CK ONLY)-REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SI NA RE OF APPLICANT DATE I�13C��U 1 q <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS — EHD USE ONLY �� <br /> Street# Street Name City <br /> C—. M a,r\ S oC o n �I;�A'I , 1 �- 1 ❑Unit 1 <br /> 079 <br /> 2. <br /> ❑ Unit 2 <br /> 3. <br /> 4' i Unit 3 <br /> VIA V <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7. <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> p Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IZSNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE" <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE 3h1105, C(/ fof— <br /> ❑/`ONDERGROUND TANK(MONITORING/REMOVAL ❑FOOD FACILITY ❑DAIRY Uw7 i f-T3PaZq_(Y <br /> ❑ABOVEGROUND TANK E]CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 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 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 a 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 /> I� Z <br /> O 0 1 ae ae. <br /> EHO 48.06 08/01/14 <br /> Received Time Oct. 20. 2014 10:48AM No- 7362 <br />