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Feb.EME _2._ 2016 1 :49PM No. 2355 Et Py-1G NUMBER <br /> ill ■ pA <br /> SAN .IOAQUINCOUNTY <br /> nor __ 1 ``ru/ GG!!JJ ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEBman ` s 1868 East Hazelton Avenue, Stockton, CA 95205-6232' <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> "`�:� r�t�� P!!BLlC EtECOE2Qs t2ELEASE APPLICATIOE� <br /> APPLICANT: AShM M C6[Ynts BUSINESS/AGENCY: i' ltblt wal✓ � <br /> ADDRESS: ipo C Hglw(w 91M. CITY/STATE/ZIP: Mg <br /> PHONE (1): (0F"30K PHONE (2): FAX OR E-MAIL: ZGII &k- q� <br /> Please allow 10 business days from date of application submittal for the records to be avhilable. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK BOX TO IXPEDITE REQUEST-$13 FE_E CASH OR CHECK ONLY)_REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �!/�/ VI c��J�- ._ DATE 2/211l <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street R Street Name City <br /> N S PU"lit* --Th ft tvvV ucc" - <br /> ❑ Unit i <br /> w waflO cl1wy- FA 'Thw)'VN >I/ <br /> a. ILfv� 1 i�v WoiL,riL41F PY�/� 1toDm (�✓� -� z-c0 n+ a2 <br /> 4. l�j�Lj,j� W 1/Jat4ll& &)1 We, F'.d - G7N^ f'L-�� 1-+n�U�-� M-16nnit 2H J11 <br /> 5- l3�15'S [Al W/O/l�i1Y✓II/�fy p�i��V/DV�t% �VI17ymn L-t.✓- LD L� Unit3 <br /> 6. 12� w �'V✓�''nu t�tVV i-- omfor LA ( ad"It 3HM <br /> 7. 1LAet �0. ❑ Unit <br /> g, Y)I/ Es SITE MITIGATION <br /> 9 �-}�1 6 NA nll5 <br /> 10. <br /> Specific Dale Range of Informatlon Requested: From to <br /> ENV_IRO_N_MENTAL HEALTH_DEPARTMENT.FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL OLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ['HOUSING ABATEMENT ❑FOOD FACILITY <br /> ©UNDERGROUND TANK(MONITORINGIREMOVAL) aWASTE TIRE �aD"�AIRY,POOLISPA <br /> r®r�ABOVEGROUND TANK ®CHICKEN RANCH/DOG KENNEL Ly WASTEWATER TREATMENT PLANT <br /> pT,I HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY (aPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑T�ATTOOBODY PIERCING LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY IYP�•OMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW' MONDAY•FRIDAY 8:00 Am-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo 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 tan(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. <br /> "`BOXED AREA-EHp USE ONLY*`* I `-� <br /> PdW u� tl Lf { ie 13 h�� LAAk wL,ir GMrt Q ` L Pro�.le l D t i v ri <br /> LQ 6 pma aae l G,Y t AK5 L�A ,rt <br /> C N ae�f �rti1,,� CC giot `61� an C9o26,4up Vl1 CD 1 tt9 t,/�In�t GNve R <br /> Receivedim�r�e6__2.�y701 �p, 1 ;44PN�No. �4343�rfNama: <br />