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1 11❑ 01/22/2015 16:07 (FAX) P.0011001 <br /> I ❑ <br /> ❑ <br /> I ❑ <br /> ❑ <br /> p❑ DATE RECEIVED EHD LOG NUMBER <br /> ❑ SAN JOAQUIN COUNTY <br /> ❑ (I f. '��IIiz' � U <br /> ' �I <br /> It ENVIRONMENTAL ENVIRONMENTAL HEALTH Dt:PARTMENT O <br /> 186B East Hazelton Avenue, Stockton, CA 95205-6232 <br /> JAN 2 3 Zpjbelephone: (209)468-3420 Fax, (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Rebecca Natal BUSINESS/AGENCY:AdVanCedQeOEnVjrOn Mental <br /> ADDRESS: 837 Shaw Road CITY/STATE/ZIP:-Stockton /CA/ 95215 <br /> PHONE (1): 209-467-1006 PHONE(2):209-623-7200 FACSIMILE: 209-467-1118 <br /> TENTAT/VE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentadve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE y126 FEE( CHC -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE L,�),D ,IT- <br /> Electronic Information: 0 List ElMap—Descrlptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - Unit 1 <br /> 1. 1947 East Channel Street Stockto 'vJ / <br /> 2. 1950Miner Avenue 6nit2 <br /> 3• 2150 East Fremont Street Stockton -loo- <br /> 4• 103 North E Street Stockton <br /> 5- 36 D Street Stockton <br /> 6• 124 North E Street Stockton -E Unit <br /> 7- 11 South A Street Stockton <br /> e. 1750 East Channel Street Stockton Q Units <br /> 10. �nit 6 <br /> Specific Date Range of Information Requested: From all to f <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X7 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOUD WASTE FACILITYNEHICLE <br /> Qx OTHER CLEANUPSITE(NON-LOP) ❑FOOD FACILITY QWASTETIRE <br /> UNDERGROUND TANK(MONITORMIZEMOVAL) DOG KENNEL [E DAIRY <br /> ❑x HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Q TIERED PERCirMED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDTHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA LAND USEAPPUCATION SITES <br /> ❑ MEDICAL WASTE FACILITY E]COW HINT RECORDS []OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:0OPM(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 1208)484-0 38.or mall 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 attar recelpt 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 some applicant may requiro a$126 deposit prior to review. , <br /> i1 � L- '" •.s�-, � 7 w � EHU�JSt Y.�. /.. � � { i ': r7- �LL7�<-i <br /> -1 �, /_ ) / '� Sr 1, . �'��.,-�-� ll.c..C.. L .t-'_'�- u ..-U°� �-r �{,J � t1. �Z.:f -• rs i.,-,�r� 'c;. <br /> �o <br /> Willi <br /> Received Time Jan, 22. 2015 3:59PM No. 7944 > <br />