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N o. 013 9 EH P, 1;NUMBER <br /> 0 ° Ef—� P— SAN JOAQUIN COUNTY <br /> I. - W9 <br /> li APR 0 0 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> I� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> J hone: (209) 468-3420 Pax: (209) 464-0138 Web: www.sigov.org/ehd <br /> NVIRONMENTALr-i 'I �= r <br /> PERMIT(SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ABUSINESS/AGENCY: I�i'f �-'� ✓I�vt M 2 <br /> ADDRESS: s33 B CITY/STATEIZIP: yV o✓ �/S� 5' a, <br /> PHONE (1): S�O-2tI�` 1338�_009_PHONE (2): FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$13 E SITOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /I DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ElUnit 1 <br /> trn <br /> 3 12 <br /> • ��D c- roc <br /> Unit 3 I <br /> 5. <br /> t <br /> g, El Unit 4 <br /> 7. <br /> g ❑ Unit 5 <br /> 9. <br /> 90, ❑"Unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLF�Vd <br /> OTHER CLEANUP SITE(NON-LOP) F1HOUSING ABATEMENT WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) F-1FOODFACILITY :jDAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL �NASTEWATERTREATMENT PLANT <br /> ]gHAZARDOUS WASTEIHAZARDOU 5 MATERIALS ❑MOTEL/HOTEL 'E]PUMPER TRUCK/YARDICHEMICALTOILETS <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-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 /> ❑ Records provided by.Staff-PPR Complete. Staff Name: <br /> Received Time=Aar, 9.;,,2015= 3__17,PM=No. 8496 08101!14 <br /> menu uo-vo <br />