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9—A-1-04 2 0 13 14:30 FAX 4001/001 <br /> RECEIVED) <br /> DATE RECEIVED EHD LOG NUMBER <br /> SEP 2 0 201 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT / <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 --ow <br /> ENVIRONMENTALhone: (209)463-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERVICC <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1301 /AAKf 111e, BUSINESS/AGENCY: VnLxok <br /> ADDRESS: N51 9 i w r Pc�T' K f CITY/STATE21 P: S�C rameA_LU CA <br /> PHONE (1): (qlh) PHONE (2): FACSIMILE: y80 000,3 <br /> TENTATIVE'APPOINTMENT DATE: ""` - _ Time: <br /> (PieaSe allow 10 business days from data of Appmatio,n submittal-*Tentative only-must be confirmed) M c <br /> SIGNATURE OF APPLICANT 1?21DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streets Street Name C Ity <br /> ❑Un it 1 <br /> 1. 70 N, Y--Ir 0c)n,oL S&-eeSL K-kovL <br /> 2. 7 �5 FL_ 00'r'j o - tree±_ oC. p US i co` Unit 2 <br /> - , 3. Y8. <br /> 4. <br /> 6. <br /> 7. <br /> ❑ Unft6 <br /> 10. Lj Unit 8 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I L ILI� r <br /> UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUrYNEHICLE((, �C, 0 <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONFTORINoIREMOVAL) ❑FOOD FACILrrY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT - <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITE$ <br /> TATTOO/BODY PIERCING COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies 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 bo accepted-for oddltlonal 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 flies 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 ging 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 thea licant- <br /> Future file reviews by the same applicant may require a$125 deposit prior to rOvieW. <br /> Rd ate <br /> -drmp::- :'1':,w ._i'' :�tf.u.-4.M'�:. 1.)) '.,. - �t� 'i:�. -'d1• ."•.�,.., — :!,:cu' .;moi - 'r,X$t"x,h.:k:: <br /> ''::,.,r ::�':. :"`l'-" N !t•,' ( t 1Ytz i3fiY'.: ..t n.. <br /> . '�:!ri'', ;•'.i t, i.iifG,{._ , — -1i t I1i< d.l f4AeP!�'_. : � :L,.'•tyb. •'n 'lev <br /> ,, .. .... ......:;. ::.::'`� :;i„t:za_ 'iJa1.'Sc. '�.� � r. xd:'k'\4.✓f'+'"• ;i.i.. Raly`: <br /> , <br /> eco o Staff-PPr� 1.k-Atatr <br /> d R rds provided ed <br /> Received Time Sep. 20. 2013 :413 M No. <br />