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RUSH <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> M A R 12; 2012 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> '10P_.C)'1j4j f,-jelephone- (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ve4+b leen/A 1�k <br /> APPLICANT- 4 B km R91 Orm USINESS/AGENCY: 'F 5o <br /> 1 <br /> ADDRESS: EDYL LPYS - CITY/STATEMP: L�Odlw C14. -1152-3La <br /> PHONE(1): P"E(2)- V_A I VtSA>m 6 DA)Ille.FACSIMILE: <br /> TENTA T/VE APPO I NTM ENT DATE: ""I Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE R�CkLIEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS �2hyf/J <br /> SIGNATURE <br /> RE OF APPLICANT DATE .2,1 12- <br /> Electronic Information: tt List Ll Map—Description: -7-ItP I WIdikl-e- V-d 06M�, CA. Ta <br /> 1-a <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City unit I <br /> L'4 T <br /> 2. -:,?Fjll�vjo U <br /> i 3 unit 2 <br /> 3. <br /> 4. <br /> Kfbntt 3 <br /> X <br /> 6. <br /> S. <br /> Cl Unit <br /> 7. <br /> 8. C1 Unit 6 <br /> 9. <br /> 10. J ❑Unit 6 <br /> Specific Date Range of Information Requested. From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IUWERGRow TANK(UST)CLEANUP SITE(LOP) OHOUSING ABATEMENT ❑Sow WASTE FAcury/VEHICLE <br /> OTHER CLEANUP SITE(NoN-LOP) E]FOOD FAcLrry ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL E]DAIRY <br /> HAmDousWASTE GENERATOR ❑CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> TIEREO PERMITTED FAciuTy ❑MoTELIHOTEL []PUMPER TRucKfYARWCHEmm Tows <br /> El TATTCdBooy NRcima El POOUSPA [_]LAND USE AmXATIONSITES <br /> [j MEDICAL WASH FAcury EICOMPLAINT RECORDS [:]OTHER(A"m SPECIFY) <br /> WELL AND SEPTIC PERMIT REcoRus ARE AVAILABLE FOR REVIEW: MONDAY-FpjoAy 8:00 A*4:00pm(EXCLUDING HouDAys) <br /> 1. List up to tort sdftsses 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(2091464-0131 or mail to jhSjA0Ma!j 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 now 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 /> 1 e a --i ellf0mali 0 vi 0 D kt4-1(y1A j o Q T in t <br /> T -r tx QT S <br /> e- LAS is 0bS01&+C'1 _tU t, H K <br /> ove <br /> TLIO 4�6K wLiv 14eip. <br />