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1 02/02/?e13 12:33 503--786-5995 FEDEX OFFICE 5303 PAGE 01 <br /> 1p❑ ` <br /> ❑ DAT �C�I I 11 V �. EHD LOG NUMBER <br /> ❑o SAN JOAQUIN COUNTY <br /> r FEB 0 2 2015 ENVIRONMENTAL HEALTH DEPARTMENT � �l <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTATA9 QkRne: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd J L� <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Aimw :bct BUSINESS/AGENCY: Ebi ons <br /> ADDRESS: Lb-0-2-0SE UEhue, CITY/STATE/ZIP: M j I / ° 92 <br /> PHONE(1): Soj-04-248t PHONE(2): 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 a appointment date and time to review the requested records. <br /> EJ CHECK BOX TO EXPEDITE R VEST-. 1 FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINF55 DAYS <br /> SIGNATURE OF APPLICANT.,,. DATE 02--02,--).'S <br /> Electronic Information: ❑ Llst❑ M p—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> ^`Street# Street Name -- - City ❑Unit t <br /> 1. V� WA I i c.o Rod .--- i r'-A c0 /— - <br /> 2. H F�teS <br /> ,,.[]unit 2 <br /> 3.4. <br /> _ ,p Unit 3 <br /> 7. <br /> Unit 5 <br /> 9. <br /> 10. ©/Unit 6 <br /> Specific Date Range of Information Requested: From to ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ( SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOU51NG ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOvAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ]WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS 0 MOTELMOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> TATToo/BODY PIERCING §E 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 ua 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 mall to the addressindicated 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. ***R_OJ_FzD AREA-EHD USE QNLY"' <br /> CI Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Feb. 2. 2015 12: 33PM No. 8002 <br />