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From:Marcus Bole & Associates 'in n 11/'12013 16:21 #014 P.001 <br /> Lj <br /> 4.! �....�' �344'J�Jfr' iiiIIIJJJfII <br /> EHD LOG NUMBE� <br /> SAN JOAQUIN COUNTY � <br /> ENVIRONMENTAL HEALTH DEPARTMENT1 <br /> Nov 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> pERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 f4yl D NTi4L !_�i <br /> �OL� BUSINESS/AGENCY: �r�G�=�R ) " <br /> ADDRESS: �l p ,Qle.oc �i2. CITY/STATE/ZIP: c✓I/�i4rt.iNA� - y5�6�,j <br /> PHONE (1): PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 11 ( Time: rI /{M <br /> ,���—" -(Please allow 10 business days from date of application submittal-*Tentative only-must.be confirmed) <br /> 2§CHECK BOX TO EXPEDITE REQUE $125F (CA OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � ���/� -'� DATE l l 0�ZIT <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street tG Street Name city ❑Unit 1 <br /> 1. 15 E Gt? N (ale/_611/' // a <br /> 2. 1337- i E✓ S� ✓� I?'LE I7�/✓ I7 �(t/�lG�� ❑Unit 2 'y <br /> 3. o S.. W I Lson/ <br /> 4 ply E AA A/ $T 2 5_4_" WSPCt_r-dN El Unit 3 <br /> 5. o � >�l o �, o,iL_4w . X4/3 f <br /> 6 - I:. �� r/� ❑Unit 4 <br /> 8. _ 1 ,/:1` (�3fA� I/f 1 �►-r>J /. (C `�-� �� �� 4 ❑unit s <br /> 10. unit LI <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> PDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITY/VEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> U-tJDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL <br /> ❑WASTEWATER TREATMENT PLANT <br /> ZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCK/YARDICHEMICALtOILETS <br /> IERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCINGCOMPLAINT/RESPONSE 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 to 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. BQKED741�Egx7=HDr15 ONLY <br /> Q=Recnrds,prow,fded bar Sta_ffPPRt-Oomplete stafrnlame ,` , � - <br /> EHD 48.06 914112 <br /> Received Time Nov. 17. 2013 5: 19PM No. 4549 <br />