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04/18/2013 21 :44 FAX 001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT c <br /> 304 East Weber Avenue, 3 I Floor, Stockton, CA 95202-270a I S <br /> i. 2007 Telephone:(209)468.3420 Fax: (209)464-0138 Web: www.sjgov.org dd l ` <br /> PUBLIC RECORDS RELEASE APPLICATION p <br /> APPLICANT: ~ l BUSINESSIAGENCY: I L.+. ]� r✓I Igi nL <br /> ADDRESS: <br /> PHONE(1): 'Mia AID 43 O 7 PHONE(2): -11(i -1 !!!S •QTS M:5 FACSIMILE: 011(0 49+0 <br /> TENTATIVE*APPOINTMENT DATE: 5I`LL'110-7 Time: (QOb <br /> IMBUE allow 10 business days from demo pphcatlon submittal-'rmtaeve only-most be conBmwd) <br /> IJ CHECK BOX TO EXPEDITE REQUEST-$98-00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �Y,ly�� DATE S I o <br /> Electronic Information: ❑List©Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> �Sytreatt - - Street Name - City \ ❑ Unit 1 <br /> LAST L.D V <br /> & 2. \ D aA� II a S{'• uST OLD) vv ❑ Unit2 <br /> 3. 11 est' <br /> , UPn3 <br /> 4• 1131 Ipo Dr,,�tt tAST oio�� <br /> Unil4 <br /> O" z <br /> _.. —y ❑ <br /> Una 6 <br /> 8. <br /> TQ <br /> V 9• Units <br /> 1X 10. <br /> Specific Date Range of IniormaUon Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 1 <br /> 91 UNDERGROUNo TANK(UST)CLEANUP SITE(LOP) 0 HouSINO AaArEMENT •d SOLM WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY O WASTE nw <br /> .�UNDERGROUND TANK(MONRORINGIREMOVAL) D DOG KENNEL D DAIRY <br /> L4 <br /> aJ HAZARoou9 WASTE GENERATOR 171 CHICKEN RANCH 11 WASTEWATER TREATMENT PLANT <br /> J4 TIERPD PERMITTED FACILITY 17 MOTELIHOTEL O PUMPER TRucKIYARDICHEM TOILETS <br /> 0 TATTOWBOOT PIERCING ❑POOUSPA 13 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE rOR RENEW- MONDAY-FIaDAY 5:00 ANI-S:OOPM - EXCLUDING HOLIOAY9. <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(209104-111133 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 N any EHD file&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 Tile 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> SNDA 6 I3m0 <br />