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RECEIVED 10 SAN vI0AQUIN COUNTY EHD LOG NUMBER FEB 0 2 2015 ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ENVIRONMENTAL H Lone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: -� . ,may BUSINESS/AGENCY• tr/C,e. /fi f ADDRESS: �`fv G�<S' AJ. Y��v 3f�i,L .� j3— CITY/STATE/ZIP: PHONE(1) ? J X3 _&1 2_ PHONE (2): duyi-- ' FACSIMILE: Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. ❑CHECK BOX TO EXPEDITE REQUEST IAYE, AS R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT �"—"` DATE Electronic Information: ❑ List❑ Map—Description: FILE ADDRESS EHD USE ONLY Street# Street Name City ❑Unit 1 1. -ZYS 7 '-. �`- (,✓mss'— Lit � s® j _.,E] Unit 2 3. ,t 4. rw+�� Unit 3 5.6. Q7 m "Unit 4 7. 8. ❑ Unit 5 9. 10. ❑ Unit 6 Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY/VEHICLE IOTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL PUMPER TRUCK/YARDICHEMICALTOILETS TIERED PERMITTED FACILITY ❑PObL/SPA LAND USE APPLICATION SITES j TATTOWBODY PIERCING COMPLAINT/RESPONSE RECORDS R'OTHER(PLEASE SPECIFY) ' WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) I 1. List uD to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one fife type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above Address ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. i 3. The EHD will notifythe applicant if an EHD files exist. An I pp y appointment for review will be confirmed approximately.ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48.06 4/28/14