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®® 01/01/2010 00:19 2093398382 MIDCAL INDUSTRIAL PAGE 01/01 <br /> ® n <br /> C� <br /> ®° EO, <br /> ������ EHD LOG NUMBER <br /> BVE SAN JOAQUIN CIO <br /> SEP ® 2Qi5 ENVIRONMENTAL HEALTH W1 Y186East Hazelton Avenue,.Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgpv.org/ehd <br /> ENMONMENTALHEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: INJ PAYOR BUSINESS/AGENCY:/"/0 Ml-- f/041r ,A�Q��S <br /> ADDRESS: legllFl�' r,�,,�"IKI� e�Il C-171 CITY/STATE/ZIP: niVaCuy Cjy� J�/ZI <br /> PHONE (1): 9 y ay �02�i�{ PHONE (2):�' 9y �/ �F38� FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appoin t date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- EASH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /! DATE — 9 /� <br /> Electronic Information: ❑ List ❑ Map- Descriptlon: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Streets Street Name City <br /> 1. F��T- N'4vr ppz s�reci47�,c v <br /> . 2. /13 J"= s/rrLl%Tddv sT_ ,PGxr4� - C /' �a�I5 ❑ Unit 1 <br /> 3, <br /> ❑ unit 2 <br /> 4. <br /> ❑ Unit zH <br /> $. O <br /> 6. 1Jnit 3 P, <br /> Q�/ <br /> 7. ErOnita <br /> 8. ❑"SITE MITIGATION <br /> 9 <br /> 10. ❑Units <br /> Specific Date Range of Information Requested: From to <br /> O,,��,,// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) [:]MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHERCLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> [a,tiNDERGROUN0 TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY ' <br /> V0VEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL E]WASTEWATER TREATMENT PLANT <br /> ARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTFUHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY. ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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(209)464-0138 or mail to the address indicated above. Address <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$130 deposit prior to review. *—BOXED AREA-EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> Received Time Sep. 10. 2015 9: 13AM No. 9539 �rti,5 <br />