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ROM ERRS Envirommental. Ino CFRI)JUL 2T 2012 t1:33/ST. ll:38Mo.7600000349 p l <br /> RE )�f d ED ... SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUL 27 2012 Hazelton1868 East Avenue, Stockton, <br /> Telephone: (209) 468-3420Fax: (209)464-0138Web:wwwsgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION + <br /> APPLICANT: 1I� BUSINESSIAGENCY: Y 1 <br /> ADDRESS: 3 CITY/STATE/ZIP: <br /> PHONE(1):S I O PHONE(2 : FACSIMI E <br /> TENTATIVE'APPOINTMENT DATE: IR Time: <br /> (Please allow 10 business from too ppii Ion submittal-'TentatAre only-must be confirmed) <br /> _ ❑CHECK BOX TO EXPEDITE RE U -$125 E( S HECK ONLY)-REQUEST PROCESSED IN BUSIN SS DAYS <br /> SIGNATURE OF APPLICANT DATEZ Z <br /> Electronic Information: ❑ List[I Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> DUI.- Street Street Name city [27Unitl <br /> n y' 1 2/11 <br /> 1UIr 2 Gl� unit2 aa <br /> 3. Q `/Z ) 5I(Dly S <br /> 4, l� lU <br /> nk3 <br /> 5. <br /> C30 <br /> 6. <br /> nit4 <br /> 7- <br /> 8. <br /> e unit <br /> 1 D. <br /> Unit <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HLT DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE F.ACILffYNEHIC j <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY E]WASTE TIRE IC) fi te <br /> NDERGROUND TANK(MONITORINGIREMOVAL)01— ❑DOG KENNEL ❑DAIRY Q a- <br /> HAZARDOUS WASTE GENERATOR( ❑CHICKEN RANCH ❑WASTEWATER TR TMENTFLANT <br /> IERED PERMITTED FACILITY'(7C ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TA7TOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:OD AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above, Select the type($)of files from the list above by checking the appropriate <br /> bbx(es)- At least one Nle 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 rile 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$129 deposit prior to review. <br /> -: USE OFif <br /> I CO 15 <br /> Irv) AH,04 1021 t&6 <br /> EHD N t <br /> 611111 <br /> Received Time Jul, N. 2012 11 :48AM No. 0661 <br />