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I� OCT-08-2013(TUE) 11 ; 37 Broadh­nt & Asssoc (FRX)l 7n7 455 7295 P. 001 <br /> �Tfi EHD LOG NUMBER`? <br /> 0■ B �� � SAN .10AQUIN COUNTY ar; <br /> ■ ENVIRONMENTAL HEALTH DEPARTMENT 9F <br /> ■ <br /> OCT 0.8 2013 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 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � "` BUSINESS/AGENCY: `-(— <br /> ADDRESS: GtITY/STATE210: <br /> PHONE (1): PHONE (2): 314� �°l FACSIMILE: d <br /> TENTATIVE"APPOINTMENTDATE: c:> -21 — t Time: <br /> (Please allow 10 business days from date of application submittal-•Tenfative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ E5 $1 5 FEE(CASH ORECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Y`'` J`�— DATE <br /> Electronic Information: Llst Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street M Street Name City ❑Unit 1 <br /> Ci Unit 2 <br /> 3. <br /> 4. � 1 <br /> ,�Unit 3 <br /> 8. ETUnIt 4 <br /> i <br /> 7. <br /> 8. <br /> - ❑ Unit 6 <br /> 10. <br /> D Unit 8 <br /> Specific Data Ranee of Information Requested: From D to <br /> ENVIRONMENTAL L HEALTH DEPARTMENT FILES I <br /> UNDERGROUND TANK(UST)CLEANUP SCFE(LOP) 2'MEDICAL WASTE FACILITY ®SOLID WASTE FACILITYNEHICWV dTIUG <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT EfWASTE TIRE 0 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> P�HAZARDOU8 WASTEMAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-g:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten-ad. reiises In the space above. Select the type(s)of files from the list above by checking the epproprlate <br /> box(es). At least one file type MUST be selected. Fax to(209)484-0138 or mall to the address Indicated above. Address <br /> ranges will not be accepted-for eddltlonaI assistance with file addresses, contact the END. Appllcatlons 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 /> Futuro file reviews by the same applicant may require a$125 deposit prior to review. BOS(ED;ARE,�,. EHD,USE.O..L .. <br /> i <br /> w' <br /> J a <br /> I <br /> :"1�•: - �•7. :'�l" ...lis i"gi.,�' <br /> �. <br /> 1I -4 <br /> ..b.,sr:' Pi,l�'.:lu�...:"�':Sd;d„ +�.t=:���et. �y_. 't�'r'.•4-!LL. 1:=� ..lWw' :i•A :A. <br /> is•. - <br /> u <br /> 5. 5 <br /> q <br /> T3!7 - "�i�' 'I ''`^•:5'''i .�F''' <br /> i.a;.r'• :_.'•. j5`a'. <br /> 11 Si "P d(fNdme.:'..r. `fit, '•' <br /> CReceived Tyime: Oct, 8' _2013_11 53AN��No, 4266 <br /> EHD 49.09 914112 <br />