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04/12/2012 12.45 FAX Z001/001 WON% DATE RECEIVED :71�_Utl y, " Ly EHD LOG NUMBER RECEI` /C[{�� SAN JOA VED ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main St. Stockton, CA 95202-3029 12 2012 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd ENVIRONMENTAL HEALTH PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: 1Y`AGIL C`-O4J�dZ�s BUS INESSIAGENCY: er'kjz l-cr1 SQFl(IGc; Irl C ADDRESS: r2 G CITY/STATEIZIP: �JtF'LEI�Tbt CA_fT621 PHONE( _ 023`I PHONE(2): 1(L g ^2v 1,9 FACSIMILE: (4/6 � 060 3 TEN TIVE•APPOINTMENT DATE: ( 2cl Time: (Please allow 10 business days from dpWof application submittal•,TamseNe only-must be confirmed) CHECK BOX TO EXPEDITE REQUEST. 5 FE H OR ECK ONLY)-REQUEST PROCESSEO IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE_/�/I Z— Electronic Information: ❑List❑ Map-Description: FILE ADDRESS EHD USE ONLY Street a Street Name city 1 1. 2$00 ClV I LI�, 0 f 1 J1� 3. 2boo GaA u 3117 N 4. 12,9tmS. Es Or�t'A<O O S I', StDCK Unit S 5. �� 5.EL 1�O21kVo Si S7oc.(c-"I�r�L 1 fl ,/ 6• c7_ canes 7. g, Unh 5 9. 10. unx a Specific Date Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES g.L DQ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILRYNEHICLE ]' OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE UNDERGROUND TANK(MONRORINGIREMOVAL).L. ❑DOG KENNEL ❑DAIRY HAZARDOUS WASTE GENERA7O@V0" ❑CHICKEN RANCH ❑WASTEWATERTREATMENTPLANT I C. TIERED PERMITTED FACILITY v- ❑MOTEIMOTFL ❑PUMPER TRUCKIYARDICHEMICAL TO E S TATToOBODY PIERCING E]POOLISPA ElLAND USE APPLICATION SITES MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8;00 AM•5:00PNt EXCLUDING HOLIDAYS) 1. List up to tan address in the apace above. Select the"(a)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 12091 1 bS o mall to the address Indicated above Address ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3;00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 9. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the some applicant may require a$125 deposit prior to review. SEO � s 7 I)YI 'kill edL 2 8 Al EHD 48,0111