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�■ EHD LOG NUMBER <br /> I■ ATE REG>= D SA JOAQUIN COUNTY <br /> o■ RECEIVEDE14VIRONWNTAL HEALTH DEPARTMENT <br /> li 1868 East Hazet on Avenue, Stockton, CA 95205-6232 <br /> AR 2 0 2 e{ephone: (209)468-342 .Fax: (20.9)464-01.3$Web-www.sjgo�r,org/ehd <br /> ENVIR NMENTALHEALTN <br /> PE MIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �" �l 11�tfE� BUSINESS/AGENCY:. E19 �I�iCS.G t, /VC' <br /> F � U 71 i� EZ,�zZ <br /> AD{3f2f= � ��� CITY/sTATP�iI': � ,�%�-/i;� m � <br /> PHONE,(1): C�)�/��—JCt i( <br /> PHO14E(2):��Ir�1-c hen �bicons u(1rACS1MfLE:M <br /> TENTATIV.ErAP.POIIVTM'ENT DATE ` n M Time: <br /> (Please allow 10 business days fromA& f application submittal-F iPJJt9tive only-must be confirmed) <br /> CHECK$OX TO E?cl'EDIT) REQUEST-$125 EE(C OR CHECKONLY)-REQUf ST PROCESSED IN 3 BUSINF_SS DAYS <br /> SiGW TUBE CF APPLICANT � tet/ 13ATE <br /> is 1nf*rrttaatkM- ❑List[]Map— criptiior: <br /> FILE ADDRESS EHD USE ONLY <br /> tr ort# I - Street Name city (�]it <br /> [2.. v tZels �-L r� kou.(1.'1Lr A t37C,Z` <br /> 3. <br /> 4 Ej lJn►t 3 <br /> 5' <br /> 6. <br /> 5/2-4 %y Urnit4 <br /> 7. <br /> 8. El unit v. <br /> 9. <br /> 10, ,Q Unit s <br /> $peclfia D XW Range of information Requested: From to <br /> E14VIROWE NTAL HEALTH DEPARTMENT VILES <br /> VUNDERG=N0TMK JUST)CLEANUP'SITE(LOP) MEDICAL WASTE FACILITY �SOUD WASTE FACILITYI)/ENICLE <br /> T1,LR L'EANtp Srm(NoN-LL P) HOIIMG ABATEMENT ®WASTE-TIRE <br /> .l INDERG tOUND TANK(MONITORINGIREMOVAL) FOOD FACILITY ❑DAIRY <br /> RA� rAlfK 7 CHICKEN"041 DOG I(E t. �WASTEWATER TIZEATIVIENTPLAW <br /> HAZARDWS WASTEIHAZARDOUS MATEMALS MOTF-040TEL ❑PUMPFR TRUCr4YA;WCHEwAL TOILETS <br /> PERE@ f ERMRTEDFA011,tT4 ' POOLISPA ❑LAw U.'3E APPLICATION SITES <br /> TATTOO 3ODY PIERCING C OMPLAINTIRESPONSE RECORDS 0 OTRER{PLEASE&-ECIFY) <br /> WELL At D SEPTIC PERMIT RECORDS ARE AVAILAB E FOR REviEW: MONDAY-FRIDAY 8:00 AM-5:OQPM(EXCLUDING HOLIDAYS) <br /> 11, List to ten addresses In the,space above. Se lect the type(s)of files from the list above by checldn_q the appropriate <br /> box(e ). At least one file type MUST be selects . fax to(209)464-0138 or mal_!to the address indicated above. Address <br /> range will not be accepted-for additional assistance with file addresses,contact the EHD. Applicatl ns received after <br /> 3:40 p will be'processed the next business day. <br /> 2.. The E D vviit.notify the.applicant if any EHD filei exist, An appolntment for review will be confirmed approximately ten(10) <br /> days receipt of application. The files will held for a maximum of five business days for review. Appointments <br /> shoul be scheduled accordingly. <br /> .3. A Title. iat is actively being worked on by EMD stAff may not ba Immediately available for review. A new application may be <br /> submi ted when the file is available. <br /> 4. Any fi not returned ln'the same.condiftn.as reloned v411.be.reorgani!Ded by EH.D staff at.the expense of the applicant, <br /> Futur.e filel.reviews by the same applicant may, quire a$125 deposit prior to Review. -BOXED AREA-ESD USE ONLY <br /> L7 Reco S A7.OVIded'by Staff-PPR COMPlete, StWNam,: <br /> Received Time`Mar, 20. `"2014` 1 ; 15PM—No. 5503 owl;? <br />