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� 1L/ 1 !/ LU1L 1Y.3U OJ1330J000 D1IVUCRGLT TUURO ^u� '-'+ '-'+ <br /> I. <br /> rN u IELGEIM E"D — EHD LOG NUMBER <br /> r� I t��X �T SAN JOAQUIN COUNTY <br /> DEC 17 2012 ENVIRONMENTAL HEALTH DEPARTMENT <br /> �P 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> LNVIRONM€NTALHEALI(1 (ePhone: (209)468-3420 Fax: (209) 4640138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES <br /> ll D(PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:CknS 3tV\ BUSINESSIAGENCY: MoLirt 1+11 <br /> ADDRESS: �(y Pn tt.& f jy CITY/STATMIP:_il", e <br /> PHONE (1): �'3 (—Z62—k-'-'.sq PHONE (2): FACSIMILE:_ <br /> TENTATIVE'APPOINTMENT DATE: I 1 Z-A- l t~ Time:i4- �ite�� <br /> (Please allow 10 twnlnesn days fromdata of ap Ilcatlonsubmittal-"I entaflve only-must be conflrmtd) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-5125 FEESH HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Z DATE I2. ( 2 <br /> Electronic Information: ❑ List❑ Map— escription: <br /> FILE ADDRESS EHD use uNLY <br /> Street!! Street Name City Unit1 <br /> �" (,0 in <br /> 2, ��� �� e - ❑Unit2 <br /> 3. 23 3 L I <br /> 4. Z�(r L , P dUnit3 <br /> g dunh a <br /> 7. <br /> g. Unit s <br /> 9. <br /> 10 Unit G. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEAL 4RTMLNTFILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIGL VEHICLE <br /> 2r�tTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT ❑WASTETIRE �Plj <br /> A�L_Il DERGROUNDTANK(MONITORING/REMOVAL� F1 FOOD FACILITY ❑ '-ZDAIRY I <br /> BOVEGROUND TANK JL ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TPEATMENT PLANT <br /> ROOUS WASTEMAZARDOUS MATERIALSi/, Q MOTELIHOTEL ❑PUMPER TRUCKr(ARDICHEMICAL TOILETS <br /> IERED PERMITTED FACILITY,/ ❑POOLISPA ❑LAND USE APPLI:ATION SITES <br /> ❑TATTOCSODY 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 typa(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)464-0128 or mail to the address indicatad 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 EHD will notify the applicant if any EHD Tiles 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 now);ppllcatlon may be <br /> submitted when the file Is available. <br /> Future file reviews b the same applicant may require a 3125 deposit nor to review. he ex nae iN thea Ilcartt <br /> A Any file not returned in the same condition as released will be reorganized by EHD staff at t <br /> y PPP q <br /> �T'S#!C< <br /> i <br /> �s r. r N' -�'°s 9wd /IIJI � a»•.a Fl.aF 't t � �PD�S. a a 7 'vv 4rr7 " s p �'T i IF' )I c � 1! � 'm � -//. <br /> T(� v „gl*t ��, rvu<Foxwt"Yei,l `r.1?'� ', in' ,aiktl �" Vli�rsA€::Z�tI'�`ul�)�5''kll't �"+" ve.: <br /> Received Time' Dec. 17. 2012 2:46PN1"No. 1BSB' °A <br /> elY72 <br />