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•mon b 55d r ray To:1209464013B Page:1/1 <br /> 1 t <br /> 1 E �e� <br /> DATE Rrzcia �D j 2 2013 1=HD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH DEPARTMENT <br /> PERMITISERVICES 1868 East'Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)4640138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. ] '(`G BUSINESSIAGENCY: V1 /4s emr-l01 SrlYcreg <br /> ADDRESS: Avt -23p CITY/STATE/ZIP: O4l(, C 61 <br /> PHONE(1): S�o � Ob�S PHONE (2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time:J FrI <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO ExPEDITE REQUEST- 125 FEE(CASH,9R C CK ONLY)-REQUEST PROCESSED IN 3 SUSINE55 DAYS <br /> SIGNATURE OF APPLICANT DATE 'Ia-.1913 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street il Street Name city ❑ unit <br /> I(vv Ga +4t er n£ Gk `7 ANri 0(JP <br /> 4. �E Unit 3 <br /> ju Ir <br /> 6. <br /> ■ n I, IY -Z co/4 []Unit4 <br /> 7. <br /> }�( <br /> 8. + ""QH D U 1!i ZJ � Unit 5 <br /> 9. �� <br /> 10. p Unit 6 <br /> Specific Date Range of Information Requested: From to . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(()ST)CLEANUP SITE(LOP) ®MEDICAL WASTE FACILITY ®SOLID WASTE FACILITY f VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ®WASTE TIRE ja -Fl i i�51 -/-D/' W/1 �• <br /> UNDERGROUND TANK(MONITORING]FREMOVAL),Z- ❑FOOD FACILITY ❑DAIRY �a2, cf - -w-1 3 <br /> ABOVEGROUND TANK k [:1 CHICKEN RANCH]DOG KENNEL MWASTEWATER TREATMENT PLANT <br /> PHAZARDOUS WASTEIHAZARDOUSMATFRIALSfC ❑MOTELfHOTEL 0PUMPERTRUCKIYARD1CHEMICA!_TOILETS <br /> TIERED PERNIITT>D FACILfiYc>e ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOO1803Y PIERCING COMPLAINTIRESpONSE 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 up to ten address s 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 41164-D138 or mail to the address ind i cateO.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 fifes 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. —BOXED AREA-EHD USE ONLY••" <br /> I tea..: �• , . . C. ... _ . .,. . _ <br /> a I r I <br /> ,� rrf n:: . ... . .. . - <br /> - <br /> D Rec <br /> .btds;,provid'ed b"y.-y. . vm.plete. 5ta'44I me . <br /> END U-06 914112 <br /> Received Time Sepli. 20134.9- I• AM-477t 51 <br />