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oda r. 22, 2013 2: 23PM SAN aIOAQUIN COUNTY NO, 0330 EIP. JGNUM13ER <br /> ENVIRONMENTAL HEALTH DEPARTMENT 1 <br /> ■ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> MAR 2 2 2013Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION 77�-� 1� � <br /> APPLICANT: ' . A n re(„) r app BUSINESSIAGENCY: -� 3 r:Z Vt ti 04W <br /> ADDRESS: t lrllj3 3 g sWlej'CA CITY/STATE/ZIP; lqqrcf <br /> PHONE(1): 9-10-1K7- 9899' PHONE(2): FACSIMILE: (Q-BSCs� s'33°I <br /> TENTATIVE`APPOINTMENT DATE: — 13 Time: <br /> (Please allow 10 buslnoss days from data of application submittal-•Tenfailve only-must bo conflrmod) <br /> CHECK BOX TO EXPEDITE REQUEST-$12 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SI ATURE OF APPLICANT DATE tel^ ;..;L—13 <br /> Electronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City - ❑U01t 1 <br /> 2. ,�— a/ A t, 4 S p N0'Q!�7 E<nit 2 <br /> 4, i Unit 3 <br /> 5. <br /> 6. [I-Unit 4 <br /> 7. <br /> 8. <br /> Unit 6 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> 747 17 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> PINDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> iGOVEGROUNDTANKO �, <br /> HER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIREDERGROUNDTANK(MONITORINGIREMOVAL)7( ❑FOOD FACILITY ❑DAIRY }❑CHICKEN RANCH/DOG KENNEL WASTEWATERTREA MENT PLANT <br /> )�1ALARDOUSWASTEIHAZARDOUSMATERIALS,X ❑MOTELIHOTFL UPUMPERTRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY pl. ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING ❑COMPLAINTIRESPONsia RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un 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 rile type MUST be selected. Fax to(209)484.0138 or mall 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:OD 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 exaense of the a licant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> . .: 2:P �1R IS :' 15':. ^ 'n Yi nflh ':�e :�'r .a'4_. : �v ,vi• <br /> Received Time' Mar. 22. 970-1731. 2: 24P No. 2620q'� Nam.Rile � <br /> eHv ae-ux e�nnz <br />