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r- <br /> •..� N../ <br /> Df' E( IV I`r�® EHD LOG NUMBER <br /> _ V SAN JOAQUIN COUNTY �C I <br /> DEC 2 3 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 a . <br /> Telehone: 209 468-3420 Fax: 209 www.sjgov.org/ehd <br /> Web: www.s' /ehd <br /> ENVIRONMENTAL HEAL1pH J9 9 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: S�`>` C� �C1< BUSINESS/AGENCY: rnk IL T np Ce r= , <br /> ADDRESS: -Pb L30k kg(*1 CITY/STATE/ZIP: S !�r_.,� ( 1l� CAy 959101 <br /> PHONE (1):1'0(09 0r74_(�_ PHONE (2): FACSIMILE: <br /> TENTAT7-VE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUE -$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED III BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City IZI Unit 1 <br /> 1. o'k <a ST c-lam C�'1 <br /> 2- ZI Unit 2 j <br /> 3. N3-7 <br /> 4. Unit 3 <br /> 5. 0 Z !3 <br /> 6. <br /> 2 (] Unit <br /> 7. <br /> f <br /> l ,c� -�;Cc�rr����-��� <br /> 8. 1 �/��h /' El"Unit5 <br /> 10. <br /> .A:: Ef Unit 6 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONME TAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) i`bMEDICAL WASTE FACILITY OLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTETIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) FOOD FACILITY AIRY <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL $41THER <br /> ASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS DTELIHOTEL UMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY OOL/SPA ND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING COMPLAINT/RESPONSE RECORDS (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-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any END 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 /> Future file reviews by the same applicant may require a$125 deposit prior to review_ ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 914112 <br />