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LI2 0 - —. 12:52:51 p.m. 03-23-2016 1 /1 <br /> I <br /> 13% I `/ EIJ SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ° 3 eee� �� 2 3 20'6 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> RONMENTAL *ne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Co\V_R_Y%"6&\\,"o BUSINESS(AGENCY:?RS <br /> ADDRESS: \7-4a) S• t2.Sb �\e CW_Q�i "3 OO CITY/STATE/ZIP: C�ntTl \L lo0(dJ3 <br /> PHONE (1): 312. 2- 62. u34>8 PHONE (2): 31 Z. a20. 0L'B+ FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. rPSc�vo y�.�w <br /> Staff will contact you to arrange an appointment date and time to review the requested records, <br /> ❑ CHECKBOX TO EXPEDITE F EST-$130 FEE(C OR C GK ONLY)- QUESTPROCESSEDIN 3 8USINESSS DAYS <br /> SIGNATURE OF APPLICANT DATE_ `Z✓'231 ZbI <br /> Electronic Information: ❑ Llst Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> 2. ❑ <br /> t235�j — \330\ W. S \3k Qp�aC \ Unit <br /> 3. L;7 o6,&s owl krw`f Ly,.�/ <br /> 'Unit z <br /> 4• 12355 �330� , 12b�1\ ,13053, I oy'y 1315\ ❑Unit 2H 13h <br /> 5• D4nit 3 <br /> LT/UnIt 3HM <br /> 7• ❑Unit 4 <br /> B. "TE MITIGATION <br /> 9. <br /> 10. ❑ Unit 5 <br /> Specific Date Range of Information Requested: FromA�.1. to <br /> 9 ENVIRONMENTAL HEALTH.DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL [:1 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑WASTE TIRE ❑DAIRY,POOL/SPA <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCK/YARD/CHEMICALTOILETS <br /> HAZARDOUS MATERIALS rrr❑lTATTOO/BODY PIERCING 19 <br /> LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILRY 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 /> �ture file reviews by the same applicant may require a$130 deposit prior to review. <br /> * BOXED AREA-EHO USE ONLY"' <br /> 2Received 1ime (Mar. 23.)t2016F10: 50AMPNo. 0615fName: <br />