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From:Marcus H. Bole & Associates 530+633+0119 05/18/2012 10:22 #239 PA01 <br /> OAT <br /> E EHD LOG NUMBER <br /> R SAN JOAQUIN COUNTY <br /> * � ENVIRONMENTAL HEALTH DEPARTMENT n <br /> $ 212 600 East Main Street, Stockton, CA 95202-3029 \w <br /> t''QY Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd v` <br /> ELIVIRONMcSLSN PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (K ZBUSINESS/AGENCY• rt' <br /> ADDRESS: yR. Cityist/ate�2ip yw{ C� ���� <br /> PHONE(1): -'L7 1PHONE(2): S.3o f I��I�//JrpaL� FACSIMILE: -530 73?701J <br /> TENTATIVE'APPOINTMENT DATE: T� DAY 27 y 11-/17651 IG Tlme:jjV,V T/m <br /> (Please allow tD business days from date of application submittal .'ants <br /> only•must be confirmed) <br /> El CHECK BOX TO EXPEDITE REQ T-$105 FEE CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINES DAYS <br /> SIGNATURE OF APPLICANT 7 DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City <br /> 1. �DMer WAY <br /> 2- �z l <br /> 3. 3 N <br /> 4N unit 3 <br /> 5. (, 0 I �P' . .�T <br /> 6. R �,ym n1AA _ � /�yinita V <br /> 7. LL o $ N o f P <br /> 8- ❑ Unit s <br /> Apq <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From Y F 1 95 ffk 5--- to Iv� <br /> ENVIRONMENTAL HEALTH DEPARTMENT�FIILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT X�(�S�O�LID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON•LOP) 0 FOOD FACILITY f=+wYASTE TIRE UP <br /> UNDERGROUND TANK(MONno'UNG/REMOVAL) � 0 DOG KENNEL 0 DAIRY (/"1 <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL O PUMPER TRUCKNARDICHEM TOILETS <br /> O TATTOO/BODY PIERCING ❑PoousPADUSE APPLICATION SITES <br /> Q MEDICAL WASTE FACIUTY F OTHER(PLEASE SPECIFY)�(-�D�❑ 5W If <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:00P - EXCLUDING HOLIDAYS. <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 1209)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 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$105 deposit prior to review. <br /> EHD S ONLY <br /> qc�r&'OL <br /> EHD G arDa/Da $`31�IZ �dl!/f'�' cIDM� � <br /> FOS L100H EI dO. COMDIAdni *CO€ 56DOi s 1n 4W{'Ie, for los l .5 , comit i <br /> 3{s <br /> (VCD7nD51 LOkJO�'1815- /nl)F19CadJC . A r n.nnl anu r_ '.w - W.,"I.. G..- M,#- ' � <br />