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9 <br /> PECEIVED <br /> DATE RECEIVED SAN ®OAQUIN COUNTY EHD LOG NUMBER <br /> DEC. 3 0 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> E R®NMENT�LHL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVICES E lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd, <br /> PUBLIC RECOftpS RELEASE APPLICATION-ra6_R <br /> APPLICANT: USINESS/AGENCY: <br /> ADDRESS: 1/1_�L 47W17 CITY/STA E/ZIP: ca <br /> PHONE (1). _ e PHONE(2): FACSIMILE: <br /> PWase allow 10 business day`s from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an ap�po- tmen date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1 sjAS CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ` <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE LY <br /> Street# Street Name City <br /> U 't 1 ' <br /> JL <br /> 7 <br /> �Un i <br /> 3. <br /> 4 <br /> 2-3 Ct9 Do I'D(y� nit 3 <br /> 6. <br /> Z nit <br /> -) y J CO P Lul AMI i ki fe4e > � -ea ch o ❑ Unit <br /> 9. <br /> 10. 1 1 <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From 7D13 to <br /> r ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> j UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY <br /> ❑SOLID WASTE FACILnYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ,HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ZOMPLAINTIRESPONSE RECORDS OTHE^"'LEASE SPECIFY) 09—jf 4ci �'S <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAY <br /> 1. List uD to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate f <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address W <br /> ranges will not be accepted.Applications received after 3:00 pm'will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 /> 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. ***BOXED AREA-EHD USE ONLY*** <br /> F < r <br /> I5 I M ?✓ lPu .7 fir► 15 A)ew(�J2Sf t , e e <br /> ❑ Records provid d by Staff-PPR Co plete. Staff Name: <br /> END 48.06 / //p //'/� <br /> 4128/14 <br />