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02/10/2012 14:50 FAX Z001/001 <br /> DATE R2 CEIVED EHD LOG NUMB <br /> SAN JOAQUIN COUNTY <br /> � <br /> ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Zc Tylephone: (209)468-3420 Fax: (209)464-0138 Web, www.sjgov.org/eh <br /> 0� � 0S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 5 BUSINESSIAGENCY; FN S__�2- toes kr~ <br /> ADDRESS, � -L �[k EI OE CITYISTATEIZIP: (A�e T� Com# / <br /> PRONE(I): PHONI4(2):_ FACSIMILE: IO t u--'�)(.a <br /> TEN ATIVE*APPOINTMENT DATE: ---�� Time: <br /> r (Please allow 10 business days from date of application submittal-'Tenfalive only-must be confirmed) <br /> I-1 CHECK BOX TO EXPEDITE iREQUEsFEE HO HECK ONLY)-REQUEST PROCLUSED IN 3.BUSINESS DAYS <br /> SIGNATURE OF APPLICANT BATE <br /> Electronic Information: ❑hist❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city n <br /> S 0 <br /> Unit 2 <br /> 3. _qoo b�aP�- PAcT�-lam TH r Nc <br /> 4. <br /> r y <br /> I Et1 0 o p <br /> nit 4 <br /> T. <br /> a. <br /> Unit 5 <br /> 9. <br /> 10. <br /> Unit e <br /> Specific Data Range of Inform®tion liaquastad: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE LW t +f <br /> UNRERGROUND TANK(MONITORINGIREMOVAL) CCG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR�f) ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY of - ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMIICAL TOILETS <br /> r TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE 1FACiLITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:00 AM-5:00PM 1EXCLUDING HOLIDAY$) <br /> I 1 <br /> .1. List MR 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 12091404-008 or mall to the address indicated sabnvg• Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 100 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any END files exist. An appointmentfor review will be confirmed approximately tan(10) <br /> days after recelpt of appilcatiom The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> S. A file that Is actively heing worked on by EHD staff may not be imMeediatoiy avallable for review. A now application may be � <br /> submitted when the file Is available. <br /> 14, Any file not returned in the same condition as released will ba reorganized by EHO staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> • wW 8E 4 ell <br /> I(� a a in CD 06 1152 7 U,'15, r <br /> t, <br /> EHD 48-M a?!il11 <br />