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ram:GEO Syntecc CConnsu :(916 5 -9498 To: 2D94640138@rcfax.con Fax: +12094640138 Page 2 of 2 VI 212013 10:05 <br /> RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> AUG 12 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENV,R0NMEMALphone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd ♦ ` <br /> pERMRISERVICE3 <br /> PUBLIC RECORDS RELEASE APPLICATION � <br /> APPLICANT:L-lrs y rs{. . BUSINESSIAGENCY: � yl4�t?c rO��F{�vt1 <br /> ADDRESS: .3c� (� .���i� [L ,{ e 2Gf CITYISTATEIZIP:.;v L2r401xa 64 io6qa <br /> : <br /> PHONE (1): �JC�.G 5 `533 S PHONE(2). $(�I S�{�(�(,Z�i FACSIMILE: C1.1 <br /> TENTATIVE*APPOINTMENT UATE:'[(/ t,k3 'is d - 3 z Tim <br /> / <br /> 1Please Allow 10 buslnass daystrom date ot8 pli�cafion sut�mlttal-'Tonrarlvoarity-must be connmed) <br /> 51 CHECK BOXTO EXPEDITE REQUEST- 125 1 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICANI �- DATE 1ZL3 <br /> Electronic Information: ❑ List ❑Map- Description: <br /> FILE ADDRESS . ... EHD USE ONLY: <br /> Street—#- ) Street Name City <br /> Q Unit 1 <br /> 2. <br /> 4- Aff�UM113 <br /> 5. i <br /> _-. <br /> 1 .. . .. _._..� _ <br /> B. �. .' .. .. Unh4 :. <br /> T_ <br /> ❑unit 5 <br /> 10. ❑unit 6 <br /> Specific Date Range of Information Requested: From to .... <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> EfUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE�F7ACIILLIT�YnIVEHICL <br /> KOTHER CLEANUP SITE(NON-LOP) ❑HOUsINO ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVALk ❑FOOD FACILITY L]DAIRY (�"J,- b, �1•� <br /> ff❑ABOVEGROUND TANK ❑CHICKEN RANCHI Doo KENNEL ©WASTEWATER TREATMENT PLANT <br /> LYO.HAZARDOUS:IAIABTE(HAZARoous MATERIAL ❑MOTELMOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> fl TIERED PERmrTEO FACILrTY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTGOIBODY PIERCING ❑COMPLAINT/RESPONSE 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 types) 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 revlew will be confirmed approximately ten(10) <br /> daysafter 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. r;,BOX D�IREA, EHD USE ONLY, <br /> � <br /> K'+�� 3 „'f 7r✓ s i .. t- "*`" r I, 110 <br /> 1 K °t ,Ya <br /> tiC1" '4€' <br /> �'.�..; ffi,;RRM,�.Z.e0!A�l►lete—;sfart]lame,. <br /> `gn1nz. <br /> Received Time Aug. 12. 2013 10:05AM No. 3852 <br />