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EC�I D LEHD LOG NUMBER <br /> DATE SAN a1OAQUIN COUNTY <br /> AUG 2 8 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> EM/1RONMENTAdne: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERVICCES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ET LJ <br /> APPLICANT: —�1�f1 � f�tM BUSINESS/AGENCY: <br /> ADDRESS: ) { 7i- /rte 7` CITY/STATE/ZIP: 'tai <br /> PHONE(1): (��`�y^ S17 -�6 68 PHONE (2): �G�t/—���r '' /ilt` 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 /> PKCHECK BOX TO EXPEDITE REQUEST- 125 FE&.(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS (�J <br /> A ^ DATE z <br /> vivAnTUR � <br /> Electronic Information: ❑ List❑ Map—Description: / <br /> FILE ADDRESS EHD USE ONLY <br /> Street# 77 LLStreet Name City ❑Unit 1 <br /> 1. � � � .✓ j} ! F ( GQ L� InL <br /> 2. L� rql 'd�L� El Unit2 <br /> WA 1 � <br /> 3. <br /> q.. Unita <br /> 5. $ z9 1 <br /> g, E Unit 4 <br /> 7. <br /> 8• ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> pecifir_Date_Rangeof_Wfo-mation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> �C UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY [:1DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 'HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> �NITIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING Q COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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$125 deposit prior to review. ***BOXED_AREA-EHD USE ONLY*** <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br /> EHO 48.06 - 4128/14 <br />