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03-12-12;02:01PM; ;916 679 2422 n 1/ 1 <br /> DATE RECEIVED • <br /> SAN JOAQUIN COUNTY FHD LOG NUMBER 1 <br /> :tENVIRONMENTAL HEALTH DEPARTMENT <br /> IV 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wv✓w.sjgov.org/ehd <br /> MAR 1. 2 2012 <br /> lNV ALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> RpMIT/SERVIU <br /> LICANT: (oT! A br BUSINESS/AGENCY: UP11 <br /> ADDRESS: lo 6A7njerq oilkl (1Q 11-rip CITY/STATE/ZIP: r&(t hiMyl <br /> PHONE(1): 9)6 -,0e?-40.7 L PHONE (2): FACSIMILE: 91�6�9-� qpp <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU $125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_ 3�IzIIL <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> ❑Unit 1 <br /> 1 2g2sa jT cfNE KD. 7 Ac <br /> 3. F 3c0 <br /> 3 ❑Unit 2 <br /> 4. � �[Unit 3 <br /> S. <br /> 6. <br /> nit 4 <br /> 8. <br /> 9 -- ❑Unit 5 <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ,I ,�` .'� `��, <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE !'^I'1 CfJ <br /> MOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE 3 <br /> 111111000003nnnU�'''''NDERGROUND TANK(MONITORINGIREMOVAL)k El DOG KENNEL DAIRY <br /> W <br /> WAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT -3-13-j2 <br /> IERED PERMITTED FACILTIX, ❑MOTELIHOTEL <br /> ❑TATTOO/BODY PIERCING POOUSPA ❑PUMPER TRUCKICATION SITES TOILETS <br /> ❑ MEDICAL WASTE FACILITY ❑LAND USE APPLICATION SITES <br /> COMPLAINT RECORDS El 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 up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 rive 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 /> EHD USE ONLY <br /> END 43-55 <br /> 811111 <br />