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MAY 022 13 <br />✓IVB/�'(.r+ls'� ���§i 'air <br />r-Gt' IIFI7i : .:/Il <br />SAN JOAQUIN COUNTY EHD LOG NUMBER <br />\ Ev.,iIRONMENTAL HEALTH DEPAR-I IviENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 _ /j•,l <br />lephorie: (209) 468=3420-Fa—x (209) 464=0138 Web: WWW.sjgov.org/ehd <br />U,H <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:G0_-Q5t7ryro m BUSINESS/AGENCY: L✓1, R S <br />ADDRESS: &G( say fi;Gku 0/� CITY/STATE/ZIP:.SCf,1r,qA?6,e)�o 1CA/C1,15'?33 <br />PHONE (1): q0& 67q )o-71 PHONE (2): qi& 7/,f --61g7 FACSIMILE: <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- $125FEE CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: VList ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />1 <br />Street # Street Name <br />Citynit <br />1. <br />R U �� 00 <br />Fri <br />M <br />�; I iAl'Im <br />5 T nit z <br />2. <br />Di -A• o ndeiisr 0,,0,;b -h., De .t Sa, 3o <br />c,,,'c <br />3. <br />r <br />Q U it 3 <br />4. <br />jjS�� � <br />'( IJ 6r` _ o <br />5. <br />Pr <br />1215 -nit 4 <br />6. <br />7. <br />❑ Unit 5 <br />9. <br />❑ Unit 6 <br />10. <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 FACILITY/VEVCLE wt ! l , j <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT F1WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) IX- ❑ FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (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 (209) 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 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 />.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. ***BOXED AREA - END USE ONLY*** <br />r tAST- C d S r 0 ` dk- fke SIiArncc <br />L -! 3: jJu, A. Ii YK L25' <br />- <br />❑ Records provided by Staff -PPR Complete. Staff Name: 5 -I'I'I Did nDi �0 cnn'IO"1i14 *LdX <br />EHD 48-06 ije4<k46e_ , i wd 6-4rCqa,'Z 11' l ' T 5 1 r7 if S. f",e2, <br />9/4/12 <br />Flu �Y <br />