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AUG -04-2015 TUE 09:20 AM COLLIERS INTERNATIONAL FAX N0, 2094755102 P. 01/01 <br />RECEIVED <br />IIATAUTOVRO15 SAN JOAQUIN COUNTY EHD LOG NUMO R <br />U L ENVIRONMENTAL HEALTH DEPARTMENT <br />EI�iIRONMENTALHEI " # 1869 East Hazelton Avenue, Stockton, CA 95205-6232 <br />PERMIT/SERViCESTelephone: (209) 468-342U Pax: (209) 464-0136 Web. www.sjgov,org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �, C`'.(�'i1l 0 ��, _1:51 Ld. ' ��'G- BUSINESS/AGENCY: L 6 wow' i - - - e�'rf" <br />ADDRESS: C1 �ji;r y Ai IV) a/ h Or CITYISTATEIZIP: -Meso rD T 6' 6'3'T2-[7 <br />PHONE (1): PHONE (2): FACSIMILE.• <br />Please allow 10 business day's 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 REDUESX- $130 FI=B (CASH OR CHECK ONt-Y) - REQUEST PROCESSED IN 3 ©USINCSS DAYS <br />SIGNATURE OF APPLICANT Qf� DATE 6-'i ` r <br />Electronic Information: [] List El Map - Description: <br />FILE ADDRESS — <br />EttD USE ONLY <br />Stroot <br />Shoot Name <br />city <br />Unit <br />2. <br />%Ill ! )� <br />i� <br />) <br />El UnIt2 <br />4. <br />�; <br />I '3� L1 1(ey q (AJX A : zH <br />ZZF <br />Unit3 <br />5. <br />7. <br />ii Unit4 <br />8. <br />= " ITE MrrIGATiON <br />9. <br />Units <br />1 l). <br />SpoclPlc Date Range of Information Requested., From SIU to � <br />ENV RONMENTAL, H ALTH DEPARTMENT FILES <br />r UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILIVIVEHICLE <br />.1"HER CLEANUP SITE (NoN•LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />DEROROUNn TANK (MONITORINWREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />,r0-MAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHoTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY LI POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATToolB9DY PIERCING ❑ COMPLAINTIRFSPONSE RFOOROS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS AREAVAILABLE VAILABLE FOR REVIEW: MONDAY -FRIDAY 6:00 AM-5:00PM (ExcLUDINo HOLmAYs) <br />1. List up to -ton addresses In the space above, Select the type(s) of files from the Ilet above by checking the appropriate <br />box(ee). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address Indicate Abqye,_ Address <br />ranges will not; be accepted. Applications received after 3:00 pm will be procesved the next businese day. <br />2. For assistance In Identifying the nature and content of EHD records, please contact EHD at the number noted above, <br />S. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ton (1 D) <br />days offer receipt of application. The ftlos will be hold for a maximum of five business days for review. Appointments <br />should be achedulod 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 some applicant may require a $130 deposit prior to review. 'R4_XED AREA -EFIQ USE ONL <br />kepvi-IT -131C <br />II ❑ Records provided by Staff -PPR Camplate. Staff Name. li <br />EHD 46-00 <br />Received Time Aug, 4, 2015 10:30AM No.9245 <br />