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V 11V014V 1;) IV. IV <br />(W) <br />n <br />IF <br />EI SAN JOAQUIN COUNTY <br />JAN 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Et4VI80NM04TALI one: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />13ERMITISFRVICES <br />PU13LIC RECORDS RELEASE APPLICATION <br />P.0011001 <br />APPLICANT:_ Rebecca Natal BUSINESSIAGENCY: Adman . _d Gela Enmiranmental <br />ADDRESS: _837 Shaw Road CITY/STATE/ZiP:_SStockton / CA / 95215 <br />PHONE (1): (209) 467-1006 PHONE (2):(209) 623-7200 FACSIMILE: (209) 467-1118 <br />TENTATIVE` APPOINTMENT DATE: Time: <br />(Please allow 10 business days from d is of application aubmlttal - "Tantetivo only -must be confirmed) <br />❑ CHECK BOX TO EXPEDITE$126 FEE (CASH K Y) - QUEST PROCESSED IN 3 BUSINESS SI/DAYS <br />SIGNATURE OF APPLICANT ,/ uDATE 11 A' <br />Electronic Information <br />Street # <br />List ❑ Map -- Descriptlon: <br />Street Name <br />1 4236 1 S State Fit 99 <br />4236 1 Hinhwav 99 (1 <br />4. <br />T. <br />6. <br />7. <br />8. <br />S. <br />iw <br />S <br />min <br />Lj,Un'1t 2 <br />4 <br />ZiZN <br />_ ° Unit 3 <br />" <br />'Un t 4 <br />n Unit S <br />..f' <br />.-1771 Unit 6 <br />Specific Date Range of Information Requested: From all to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />x❑ <br />UNDERGROUND TANK(UST)CLEANUP srrE(LOP) ❑HOUSINGA13ATEMENT ® SOLID WASTE FACILRYNEHICLE <br />®OTHER CLEANUP SPTE(NON-LOP) ®FOOD FACILITY ❑x WASTE TIRE <br />® UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ® DAIRY G FI(e5 <br />® HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />® TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCWYARDICHEMICALTOILETS <br />❑ TATTOOIBODY PIERCING ❑ POOUSPA Q LAND USEAPPLiCATION SITES <br />❑ MEDICAL WASTE FACILITY ® COMPLAINT RECORDS [l OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY.FRIDAY 8:00 AM-6:00PM (EXCLUDiNG HOLIDAYS) <br />1. L&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. Fart to (209) 464-0138 or mail to the addmajnd[qaj2d_qhgya, Address <br />ranges will not be accepted • for additional assistance with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business clay. <br />2. The EHD will notify the applicant if any EHD flies 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 />3. A file that Is @ctively being 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 the applicant <br />Future file reviews by the same applicant may require a $126 deposit prior to review. <br />F:H0 USC ONLY <br />C -t 14 L✓ ' f0 r y 520 W" <br />e lt� L 00 U\� e fkte_ <br />dl Ol.61ek ej.9(3�) 0i i N F*_ 6r '),-�h �. K%140% C F vAtb-je 401 l e, -5rt"fie T�1 sf.A. 10111 <br />Received Time Jan. 8. 2015 10:03AM No.7865 <br />