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%- 10/13/2015 13:24 209-736-4730 COPY CENTER PAGE 01/01 <br /> e <br /> tt <br /> t <br /> F! <br /> M <br /> $a DATE RECEIVED SAN JOAQUIN COUNTY) EHD LOG NUMBER <br /> o RECEIVE` ENYIPONIENTAL HEALTH DEPACTfAENT <br /> f 1668 East Hazelton Avenue Stockton, CA 95205-6232 <br /> OCT 13 2015 Telephone: (209)468.3420 Fax: (209)464-0133 Web:www,sjgov.org/ehd <br /> ENVIRONMENTALHEALTH PUBLIC RECORDS RELEASE APPLICA.T€ON <br /> PERMACANT;S <br /> APPLICANT; t n e � 13USINESSIAGENCY; F2.+r 0_1 oA 1 )c <br /> ion � rjch.� <br /> ADDRESS: 2 Z Pi S+'a. t ClTY/STATElZFP: LQ�i C_A gyri 2_ <br /> PHome(1): G^Ocj--I`IO -0731 PHONC (2): FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff Will contactyou to strange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SICv:ATURE OF APPLICANT I btu e DAT E PO- 12- IS <br /> Elnctronlc Information: ❑ List❑ Map-Deschption: <br /> FILE ADDRESS <br /> street IY Street Name city EHD USE ONLY <br /> 1. '1215 I N_ 7kor-nfon P,d I n, cw!) <br /> 2, 13501 N . Thor-n+a,) IZcL , Lo cI. i Njr �� �uarc1 <br /> 3• 1393(c N . "1-ho�nban P.Ct- L<5 CL 1 621AMMr-eD_ UnIt2 <br /> 4• 112 u0 N . _71-LorY\+Ar tzd. Lo cl A/FF Unit 214 <br /> S. 123-10 N • `TT of y-i-bar\ 4y d Lodi il�) Io'yl <br /> G. 11 (95S N. 1h0rn+avy Rd Lo oL' <br /> El tJnN 3 <br /> 7. 11501 N . 14.�rnn�or Ra L.oCLP l� to t� ❑Unit 4 <br /> 8• I' 14 t9'A N- P_'C( Lo ar SITE remGATtoN <br /> S• i ji (9_$5 N , o r. 2a- LoC <br /> N- 1 I1 ,C rl'LVOY) R-'C1 Lo d i v N -LO U-Cv�)-L, nit 6 <br /> Specific Dale Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDMOROUNO TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WAI,it FACILITY <br /> El OTHER CLEANUP SITE(NON-LOP) ❑ FACR1tYIVEHIOLE <br /> ❑HDU9ING ABATEMENT WAST TIRE❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONrl'ORNGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCHf DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASrEMAZARDOUS MATERIALS 0 MOTELIHOTEL ❑PUMPER TRUOKIYARDICN&MCAL TOILETS <br /> ❑TIERED PEaRmuED FACiLTi ❑PDOLiSPA ❑LAND USE APPLICATION StTEs <br /> ❑TATTOo10oDY PIERcfNo ❑COMPt AwmmPONSE RECOR0s ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PFt(EXCLUDING HOLIDAYS) <br /> 1. Lls4 up to top,addrssses In the space above. select the type(c)of flies from the flat above by checking the appropriate <br /> box(es). At least one file type MUST be selected, 13,$o[jrn2jj 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 EHO at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed approximately ten (1 D) <br /> days after receipt of application. The flies 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 condttlon as released will be rootgantzed by EHD staff at the expense of the applicant. <br /> Future file reviews by the same appncant may require a$130 deposit prior to MWAW. ""BOXED AREA-EHD USE ONLY" <br /> rov l �e R art Il l� 51 Lori-� c� Nrw }tie yor I( �i 17S arl <br /> ❑ Records provided by Staff-PPR Complete. staff Names: <br /> [?HO ID-0e M119 <br /> Received Time Oct. 13, 2015 1 : 23PM No. 9777 <br />