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04/18/2013 21 :44 FAX la 001/001 <br /> GATE RECEIVEDr EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY' <br /> =A1 Lj) ENVIRONMENTAIL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,'l CA 95202-270 <br /> 2CF07 Telephone;(209)468-3420 Fax: (209)464-0138 Web: VAVW: .sjgov-4jd <br /> PUBLIC RECORDS RELEASE AP'PLICATION <br /> -R 64 —BUSINE"SSIAGENCY: 6"'n:Cr(-"A:A <br /> ADDRESS: I A 124eesLeN 4. p 0 q I-,Z !2-1 <br /> PHONE(1):Lnl("A 5a n :1 PHONE(2): <br /> —FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> --5j,Z9.7>j0- <br /> __2 4 - :� Time: <br /> (Plefte allow 10 business day*from dahl'of application submittal-'Tj5nffftjieo only-Must be confirmed) <br /> iI <br /> CHECK BOX T6 OMEorTE REQUEST-$95-00 FEE(CASH OR CHECK ONLY)-,REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE . S-111 10-7 <br /> Electronic Infonnatlow [j List C1 Map-Description: if <br /> .FILE ADDRESS END USE ONLY <br /> Stnw a Street Nama City <br /> Unit I <br /> F ('9 <br /> El unit 2 <br /> 2. <br /> 3. <br /> 4. b Unit 3 <br /> 41. <br /> A.v <br /> (V <br /> ❑ Unit 6 <br /> 8. <br /> 0 <br /> unit 6 <br /> 10, 111r <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DSPARTMENT FILES <br /> Id UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HoWiNG ABATEMENT <br /> SOLM WASTE FACILITYIVI[KtCLE <br /> 19 OTHER CLEANUP SITE(NO"OP) M FOOD FAciLrry C3 WASTE TIRE <br /> 99 UNDERGROUND TANK(MONITORING/REMOVAL) 0 DW KENNEL C3 DAIRY <br /> HAZARDGUS WASTE GENERATOR ❑CHICKEN RANCH C1 WA9TEwATZR TREAT mEwr PLANT <br /> TIERED PERmiTrED fAciLtry moTEL(HOUL C3 PUMPER TRucK1YAnufCHFM TOILE12 <br /> TATTooffiooy PIERCING PCOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WA5TE FACILITY 0 OTHER(PLEASE SP[CIFYJ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY,8:00 AJ":OOPM - EXCLUOING HOLIDAYS. <br /> i. List up to ten addresses In the space above. Select the type(s)of files from ihe Ilet above by checking the appropriateFo <br /> box(oa). At least one file type MUST be selected. x to(209)_48_4-0758 or ill t* i address Indicated ab2a. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant If any EHD files exist. Art appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be field for 8 maximum of fivi.1busineis days for roview. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is activvly being worked on by EHO staff may not be immediately O'lvallabie for review. A now application may be <br /> submitted when the file is available. <br /> 4. Any file not rgtumed in the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require$95.00 deposit prior to review. <br /> END USE ONLY <br /> RM 4544 W1 3x W5 <br />