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60 1 f—� ll /"' -/2013 18:2'1 #014 P.001 <br /> From:Marcus Bole & Associates r, r-�, i + <br /> I E3 <br /> Li <br /> EHD LOG NUMBE (� <br /> l� AMMVED SAN .IOAQUIN COUNTY ,1 <br /> ENVIRONMENTAL H <br /> A HEALTH DEPARTMENT <br /> Nov Is W3 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> EW PERMIT SERVIENTAL CESLTH <br /> ' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> C[MVIpA t/I DBUSINESS/AGENCY:-.-_g NTAL LTH <br /> APPLICANT: <br /> �OLi; Gt` �_ <br /> ADDRESS: 1 p 11 ,Qjl.oc r` !/Z CITY/STATE/ZIP: I.Alzi4rt./f•NA, c-4- <br /> PHONE (1): jp-y/S- lav 3 PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 11 Time: I/ <br /> ,�, — (Please allow 10 business days from date of application submittal-*Tentative only-must.be confirmed) <br /> CHECK BOX TO EXPEDITE REQUE -$125 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT- �2iir%r�''� DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> F1FILE ADDRESS EHD USE ONLY <br /> Street of Street Name <br /> 2CS fV C-t-ity Q Unit ry'v <br /> 1S 3 - ,912 S1- ln{'V' 1?,Ck[OA/ I-)l2 G(>li/��C�r ❑Unit 2 ►}� <br /> 3. D S. W1Ln/ lo p' DiS�S ' � <br /> 4. pd zE MA tV ST 2�5'� �' iacttvA/ 2n�J Ly,�ea�✓C�� <br /> EI Unit 3 <br /> 64' <br /> ---- rl�A p Unit 4 <br /> 8, l /' lv"1� J I/1 /t%►�rr v (: 1 <br /> C a <br /> r a y .. ❑Unit 5 <br /> 9. ; <br /> 10. i Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> JB ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL <br /> ❑WASTEWATER TREATMENT PLANT <br /> 90AZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL 7TOILETS <br /> IERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING �.COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S: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-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 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 /> 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$725 deposit prior to review.7. <br /> '"BOlCED7AF�EiQ EHD1ISE ONkY <br /> } _ <br /> .. ...� ., __. - .;'_ a .:: ..\. • - <br /> Q_Records proTridec7 by Staff`PPR"JI3omlee, start nlame - <br /> _. _ .. <br /> EHD 48.06 - 9/4/12 <br /> Received Time Nov. 17. 2013 5: 19PM No, 4549 <br />