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i <br /> r EHD LOU NUMt7GK <br /> ��® SANJOAQUINCO�flff N Wy ll �LOZ 5 'd;S awil P;AI ;3;� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 5 2013 1868 East Hazelton Avenue, Stockton, CA 95205,-6232u - <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: ww .sjgoorg/ehd l <br /> wv <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 42:016,4-e- BUSINESS/AGENCY: AFT <br /> ADDRESS' ?-15 D;a'kit, CITY/STATEIZIP:Ua)11tt-Crc[k(e-A/9q5;? 7 <br /> PHONE(1): (115)1 y&-�D00 PHONE (2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE; Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-most be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT- DATE 9I.5/ZD13 <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 Unit 1 <br /> 1- p-7 rn a STS _51at-kto!, T <br /> 2. ga0 �. 5: l S _ T C Unit 2 <br /> 3. 1.4 r,).i <br /> 4. .Unit 3 <br /> 8 - Zlilv-,S ee^_ to�lS� 0,6nit 4 <br /> 7. <br /> 3 _3 <br /> $ ! ❑Unit 5 <br /> 9. <br /> 10. Q Unit6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> 14 4THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> 4l NDERGROUND TANK(MONITORINGIREMOVAL) ❑Foot)FACILITY ❑DAIRY <br /> ©/ OVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> [WIAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUKOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOI80DY PIERCING I R COMPLAINTIRESPONSE RECORDS ❑OTHER(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 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$125 deposit prior to review. " ggm�eRFIAauL!REIGINL�r <br /> r rw+oT`FI'�`R;';.....:N .. <br /> _r:.; <br /> .r <br /> .r <br /> - <br /> ,: _ ..-"'..1.._ ... 1.•_a:'cr-'•_. " .... v_,._ _ .. _ <br /> _ P' :Q. lets <br /> "Recii�- ided�•b �;f�=P.. R..... ,-p,- ��.. _EHD 48.06 OD <br /> E3_ <br /> 7n/TO 7CtHJ CIhIHI-InCKInI'l T7r]H canaail)r= OT'TT CTn7 /r'.n/C <br /> O <br />