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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD Loc NUMBER <br /> Alll- <br /> L4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT600 East Main St. Stockton, CA 96202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464 0138 Web: www.sjgov.org/ehd <br /> iqIq <br /> PUBLIC RECORDS RELEASE APPLICATION I, <br /> APPLICANT: rg Avia 11h ca 4 BUSINESS/AGENCY: -a( f�l�rScr }�'���ytagevl� <br /> ADDRESS: ,0, Y. oZs6/ CITY/STATE/ZIP: Ort 10�A I GA g`tS(o3 <br /> TEN <br /> PHONE(1): ITATWE-,1,5-`j a$-O}�1�i PHONE (2): q>s ;215'6°!�j FACSIMILE: 44r3 gs>;�4�7 <br /> APPOINTMENT DATE: <br /> (Please allow 10 business days from date❑ of application submittal-• Time: <br /> Tentative only-must be confirmed)CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3BU INESS DAYS <br /> SIGNATURE OF APPLICANT <br /> onDATE �/ 3 aCrrO <br /> Electric Information: ❑ List❑ Map- scription: <br /> FILE ADDRESS EHD USE ONLY <br /> Z - <br /> Street# Street Name - <br /> CKy <br /> __Unit 1 <br /> 2 !-_����ares _ _ - Stcci"�1'dn _ �J t�lk�t�t�-fA' j <br /> 3. ----t1g-._—_ r•wstl fGt4 � _' 1 ... El Unit 2 <br /> 4. 'PLEASE RESPOND AS SOON AS POSSIBLE. — <br /> 5, I NEED TO NOTIFY APPLICANT DURING --- ----- -- , n',t 3 �y <br /> WEEK OF 5/14/12 IF EHD HAS FILES FO / <br /> 6. o <br /> 7. LISTED ADDRESSES OR NOT. 8'Urnn 4 <br /> -9 _-_-._ _- __. - ___ I -- _. .- i'C" ❑ Unit S <br /> 10 <br /> Specific Date Range of information Requested: From ❑Unit 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES to <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY9El SOLID WASTE FACILIFYNEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑WASTE TIRE <br /> ❑HAZARDOUS WASTE GENERATORElDAIRY <br /> El TIERED PERMITTED FACILITY ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑ MOTEtIHOTEL <br /> TATTOOIBODY PIERCING ❑ ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑ MEDICAL WASTE FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> 1. List uo 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 fiile type MUST be selected. Fax to 2091 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 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. <br /> HD 48 <br /> ._21-11 : 0°3AA 2 , 14 1 Ale / 177-7 <br />