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IA)7/,1/2014 12 :28 FAX 925 948 9988 ERM WEST WC Z001/001 <br /> i0 <br /> �0 • • EHD LOG NUMBER -� <br /> lR jE'��f �® SAN JOAQUIN COUNTY 4 <br /> JUL 12014 ENVIRONMENTAL HEALTH DEPARTMENT 1� <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 VVV <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL <br /> PERMIT/SERVICES HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: PYA 1 BUSINESSIAGENCY: @W. p <br /> ADDRESS: t/C#k f4VA �5a G ILS CITYISTATEIZIP: kpji hgt . MS 1� <br /> PHONE (1): �L�g Z 3 zl PHONE (2): QMH igSAI Zdt. K7dZFACSIMILE: qZj. 9sj_L,2-jtk <br /> Please allow 10 business days from date of application submittal forthe records to be avallable. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-E125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_�_J'� <br /> Electronic Information: [] List❑ Map—Description: <br /> FILE ADDRESS EHD USE.ONLY <br /> street# Street Name Clty _ ❑ Unit f <br /> 2 , unit <br /> i <br /> 3. )� <br /> 4 2/unit 3 <br /> 5. <br /> 3. Unit a <br /> 7. <br /> 8 ❑ Unit 6 <br /> 9. _ <br /> 10. Ll units <br /> Specific Date Range of Information Requested: Fromto / <br /> ENVIRONMENT`tL HEALTH DEPARTMENT FILES <br /> NOERGROUND TANK(UST)CLEANUP SITE(LOP) EDICAL WASTE FACILITY 9110OLIDWAFTEFACILITYNEXICLE <br /> �/OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT E]WASTE TIRE <br /> VI DERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> OVEGROUND TANK F-]CHICKEN RANCH/DOG KENNEL ZLASTmATERTREATMENT PLANVW-AT d+" <br /> ROOUS WASTEIHAZARDOUS MATERIALS ❑MOTELMOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> [ittIERED PERMITTED FACILITY OOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTGOIBODy PIERCING COMPLAINTIREsPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List Lia to ten addresses in the space above. Select the types)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 of_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$126 deposit prior to review. "'BOXED AREA-EHD USE ONLY" <br /> IFl / IA he tom) � 14MMP File. d A) <br /> C) 35tif7L-7 Zo 31 <br /> 6- <br /> 0 <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> U29tIA <br /> EHD Daae <br /> Received Time Jul. 1. 2014 12:56PM No. 6479 <br />