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■1 L234-0538 Line 1 r .� ......, , <br /> r 1 P�"4:08 a.m. 07-31-2012 1 /1 <br /> i <br /> 'RECE SAN JOAQUIN COUNTY �~ <br /> ■ <br /> i ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUL 3. 1 2012 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> jpMahone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH (10qq <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APM332hNdS»t, BUSINESSIAGENCY:_ NrjDaL 64,P-'M jDAAIOtDGf1$ <br /> ADDRESS: �68 FT2AN)- WIE;Si 14.12.. SUITE 1 CITY/STATE/ZIP: nj ( ICIMtCA, 15201, <br /> PHONE(1): (209) 234-051t3 PHONE(2): C2oq) 728. 5161 FACSIMILE(20) 1-34-05a6 <br /> TENTATIVE*APPOINTMENT DATE: _IVV>UAq {tUC,• 144k Time: 0400 <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$1 5 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7-3I'7.012-. <br /> Electronic Information: ❑ List Ma escription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1• q'L5 6. MINM AVE. ftcr m An cWilao <br /> 09 <br /> IJ 2 2 E. 1,190SAT ST. Uf ❑Uni12 <br /> * 3. 100 L-IND 5T ffTO[tL <br /> 4• i0) E. L(ND A4 LUnit3 <br /> s• S s. 1. a A-t ST0�u L/ <br /> 6. qC0 u4UN t ALJ Unit 4 <br /> 7• <br /> B' 3o M, t W R'0 Units <br /> 10. X20 t3- STD hl N rt 0 it,-5,0(w El Un[s <br /> Specific Date Range of Information Requested: From )Cl7(J to PtZGS£N'r <br /> N( <br /> ENVIRONMENTAL H ALTH DEPARTMENT FILES <br /> �N UNDERGROUND TANK(UST)CLEANUP SITE(LOP) L1 HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHIC <br /> LCIOTHER CLEANUP SITE(NON-LOP) L1 FOOD FACILITY ❑WASTETIRE/l�'1�f��,121�o � If <br /> WrUNDERGROUNO TANK(MONR7ORINGIREMOVAL) ❑DOG KENNEL DAIRY ^� 7'1-("Z <br /> I�J/HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 171WABTEWATER TREATMENT PLANT <br /> IJ TIERED PERMITTED FACILITY ❑MOTELIMOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICALWASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List unto 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. <br /> EHO USE ONLY <br /> - - rn tne (A 15T P r <br /> - z n <br /> Tel <br /> ( flD�S 5 <br /> ReC,eiverl 'D me Jul, 1. — Zy1 :1�ATVrNo1 InMrCID a, <br /> 1+ I-1g0(0 1 nP{.-4 8 for :;;oAtt.t'Ora., <br />