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1 �lf�tFWLo <br /> n10.550((59 To:120996401313 Page:lel <br /> TE DA REC 12 20I3 EHD 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) 464-0138 Web: www.sjgov.org/ehd <\A <br /> L <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: 'y' 4ASSGS$,-O seg <br /> •rcy <br /> ADDRESS: r A -&145 CITYISTATE/ZIP: (341( C,A �K611 <br /> PHONE (1): 5\0 D!� 06&S PHONE (2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 1 4s'. 101'g Time: 1 V1 <br /> (Please allow 10 business days from date of application submittal-'Tentadve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 125 FEE(CASH C CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE r1 Il ao13 <br /> Electronic Information: ❑ List❑Map—Description: <br /> ©� FILE ADDRESS EHD USE ONLY <br /> Street p Street Name City - ❑unit 1 <br /> 1&xr16 Gu Per nt cIL ' <br /> 7. `30 • ND � Unit2 <br /> ,w ,.u1 ,l�Trif 1, <br /> • A)C i .IJ Unit 3 `CJ. q� <br /> CR <br /> T1it3 �f <br /> 6• 1 116q [:9'l'nit 4 <br /> T. 1�Oc6 ua unI t 3coGio <br /> B. Opo IJ c, ut i rj '❑unit 5 <br /> 9. g� tih v0 sol 41 <br /> 10. Q Uou s <br /> Speck Date Range of Information Requested: From1t7i5{ i to pdant� <br /> ENVIRONMENTAL HEALTH DE ARTMENT FILES —1_ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ®MEDICAL WASTE FACILITY ®SOLID WASTE FACILITYIVEHICkL,E� <br /> OTHER CLEANUP SITE(NDN-LOP) ❑HOUSING ABATEMENT ®WASTETIRE i,, -FII( ' /vim 1417/'�' <br /> UNDERGROUND TANK(M/ONITORINGIREMOVAL}� ❑FOOD FACILITY E]DAIRY 1Gg C'(- ZD-13 <br /> ABOVEGROUND TANK G\ ❑CHICKEN RANCHI DOG KENNEL 2LWASTEwATER TREATMENT PLANT <br /> PHAZARDOUS WASTEIHAZARDOUS MATERIALS_-C ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILrrY(:)/, ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOOISODY 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 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 file type MUST be selected. Fax to(20 8)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 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 /> -l�.` r 1X 13 <br /> .: t• 3L �xSS- 'i9(� rl � ' �Ifi. <br /> .l )f: •t :.. �. <br /> q 5 r d(o <br /> . , : � : ..: .. .. i: : : . :. � ir, i : : SII ` • o, .. - � , -�� <br /> Q Recotds.;provided bSi;Stai 'PP. ,.i;omplete, s!afT_Naine;. <br /> EXD 48A6 9lN12 <br /> Received Time Sep, Q. 20134G-r-0 <br /> �1 .: r�/d1j'7 0 . <br />