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om:Wendy,Digiorno Fax:(877)766-6495 To: Fax: +1 (209)464-0138 1,7e 2 of 2 1111812013 11:01 <br /> EHO L�",RZMBER <br /> I�ED SAN J OAQUIN COUNTY 1 <br /> 013 ENVIRONMENTAL HEALTH DEPARTMENTS ,f U <br /> NOV 1 2 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Tetene: (209),468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehdi <br /> ENVIRONMENT LEs <br /> pERMITISER 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: k-e'7 D BUSINESS/AGENCY: P0_*-A to <br /> ADDRESS: 7iZn I Fyx ,� ,/5 CITY/STATE/ZIP: LA <br /> PHONE (1): 91(,- O.Co-33 3 U PHONE(2): FACSIMILE: V q??= 44o to - <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Gl(Q� , �( L ` DATE I.III�f 13 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> //Street# Street Name , ' C Ayry rp City <br /> Unit I <br /> 2. _.. <br /> 3 ❑Unit 2 <br /> 4. <br /> Q Unit 3 <br /> 5. <br /> S' (J Unit 4 <br /> 7. <br /> 8. _ �41 ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From tf I f to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSINGABATEMENT � 'V <br /> ❑SDLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE � x 1� <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUSWASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 A.Mr5:00PM(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(203)464-0138 or mail to the address indicated above. 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 day. <br /> 2. The END 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 /> 3. A file that is actively 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.$125 deposit prior to review. <br /> =_rs_UeS OtiLY <br /> EHD 48-06 gl�It <br /> Received Time Nov. 18, 2013 11 : 02AM No, 4551 <br />