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NOV/22/2011/TUE 11 :24 AM DT" FAX No, 9162556"? P, 001/001 <br /> FAD EQ SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT V <br /> �� Z 2 25.11600 East Main St. Stockton, CA 95202-3029 _ <br /> Telephone: (209)468-3420 Fax: (209)4640138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL I.IAHEALTH V► <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: j ivv_ .'S BUSINESS/AGENCY: CA <br /> ADDRESS: SgOo re-Q k_;zr bvF, , CITYJSTATE/ZIP; S�_C 1 T582(r <br /> PHONE(1): `l 16 • 2_-'7 J•- "j LIC) PHONE(2): FACSIMILE:ql (� • 25 S-. 36Q/o <br /> TENTATIVE'APPOINTMENT DATE' Ib Time: t>Co ('700 <br /> (Please allow 10 business days from date o4 appiiaageb suhmkfal•`TentaOve only-must be confirmed) <br /> ❑CHECK BOXTD EXPEDITE REQUEST-$125 FEE(CASH OR PHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT { U N�Lt (/ �y1 e) DATE <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Simi/ Street Name city Unit y <br /> (_�J�-�� 1. "S(� 6(� �, 1 r�.•r- 1 ah` �o FY'e r�c1r-�� �a.>,. /�N ,N J <br /> V 2. IZ`g 11 r OP.� I-. L°T'oY'c 7 ❑Unl <br /> 3. i�� f-l-7. r ori L^ sj-0 C -0 1�a9A�� ew <br /> 6ao o nit3 <br /> 5. <br /> Oil CD na 4 <br /> 8. <br /> 7 <br /> 8 Unl 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Speck Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLD <br /> ' )UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT WASTE WASTE FACILRYNEHICLE <br /> RY <br /> OTHf-31e <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY DWMASTE TIRE �,yl 1 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)OL ❑DOG KENNEL ❑WAS-TEy,1ATE'TREATMENT PLANT IZ <br /> HATARDOUSWASTEGENERATOR D< �❑rry]CHICKEN RANCH ❑ <br /> TIERED PERMITTED FACILITY 1>1 F1 MOTEL/HOTEL ❑PUMPERTRUCK[YARD/CHEMICALTOILETS <br /> F]TATTOOJBODY PIERCING ❑POOLISPA El 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 AM-5:OOPM(EXCLUDING HOLIDAYB) <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. Fa to 209 484.0138 or mall t0 th 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 he 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 flies 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 notbe 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 /> It . e h0177 ►�s <br /> 2—b— 4 D©75 <br /> 0 301(4Q., 6000 006 „ <br /> �"�"°° art ;n � rt;ferrcLl d�aii-(-iP►+w Rl� {o.-�4 4� ,o/rp©r t; LoM G�U.J n�- .1� <br /> (.00D31-D-)5 .; s 1 A J G,L +1-tA) �i'le f0/ IZbll A�ia.�d f . 1643 <br />