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Sep 09 3 10:24a URS 41 r,8829261 p.2 <br /> • bh i <br /> DA � <br /> �, •• A D SAN JOAQUIN COUNTYVr <br /> EHD LOG NUMBER <br /> SEP d 013 ENVIRONMENTAL HEALTH DEPARTMENT 9\411g <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> RoNMEpLlone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd <br /> Ew <br /> PERMITISEFMCES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: LRES_cC rp. <br /> ADDRESS: r 1 ti e ( Uj& CITY/STATE/ZIP: tlFra%ci5ec� I Coi`lg <br /> PHONE(1): PHONE (2): FACSIMILE: -115 -- M92GI <br /> TENTATIVE*APPOINTMENT DATE: <br /> Aa(:)F3 Time: jl:0012" <br /> (please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> [—]CHECK BOX TO EXPEDITE REQUEST- FEE(CASH R E ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Gtr / DATE <br /> Electronic Information: [] List❑ Map—Description: <br /> UFILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 1 <br /> �4no ct -p NlM '} <br /> 1. 1_7400 W � f <br /> 2ck\. 8 A ` C_ S'1 � (EQ&QVnIt 2 I t <br /> 3. 17 j On cc 5p z <br /> 5. � <br /> 6. U UniUnit4 <br /> 7. <br /> _E Unit S <br /> L10. <br /> Aa it s <br /> Specific Date Range of Information Requested: From t-�1 �.IP�bP�^�PJ►rI� <br /> ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) EDICAL WASTE FACILITY OLID WASTE FACILITYNEHICLE <br /> E�P97HER CLEANUP SffE(NON-LOP) [.HOUSING ABATEMENT [ ASTE TIRE 1 \Ie a i7 I�j <br /> QjNDERGROUND TANK(MONITORINGIREhIOVAt) ❑FOOD FACILITY AIRY <br /> ✓XBOVEGROUNDTANK ❑CHICKEN RANCii/DOG KENNEL ASTEWATERTREATMENT PLANT <br /> ZARDOUSWASTENAZARDOUSMATERIALS ❑MOTELIHOTEL �MPERTRUCK/YARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY POOUSPA AND USE APPLICATION SITES <br /> ❑TATT00/BODY PIERCING RCOMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 ANI-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(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 file is available. <br /> 4. Any file not retumed 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 Jt GI ® S r co /OS <br /> cjA ga-z-04t <br /> Received Time'cSep. . 9. 1y2001A0:.11.AMON.o. 4002Staff Name: <br /> EHD 48-06CI.r6_16 Pro LtJ�t kkpJ�l+/ (I(�f7(Q 16- js iFY1)v QMP�J�MMP� 9!4112 <br />