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RPR-3-2012 10:42A FROM:GEDPHI'SE ENV 2095690295 —0:4 01 <br /> feft P.2 <br /> -RECEIVED L <br /> SAN .IOAQUIN COUNTY EHO LOG NUMBER A <br /> Lk 0 3 2012 ENVIRONMENTAL HEALTH DEPARTMENT � <br /> TTeele h 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENTALHEgi3h ne: (209)468-3420 Fax: (209)464-0138 Web: www,sigov.org/ehd <br /> PERMIT/SERVICES 1nPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,j7?V&, ler14 r� BUSINESS/AGENCY: o �qs fir, <br /> ADDRESS: X937 I�PNP4+t /Iy C CITY/STATE/ZIP:: <br /> PHONE(1): 3f�% 0.293 PHONE( ):_ <br /> TENTATIVE'APPOINTMENT DATE: A/ 4 3 Time: <br /> (Please allow 10 business days from de a of application submittal-'rents dve only•must be confirmed) <br /> 'CHECK BOX TO EXPEDITE REQUEST'-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_.,t/4 DATE <br /> ElFectronlc Information: ❑Llst❑Map-Descptlon: <br /> FILE ADDRESS ___ _ _ �A EHD USE ONLY <br /> 1. street Street NameCity <br /> _ - ni <br /> 2. 2S3Vr3 <br /> !�r <br /> D� 4�L��l <br /> 3 <br /> 4. t <br /> s. 554 ,NQ cOjS- _3_ �( <br /> s. — nit <br /> 7. <br /> 8. _. _ <br /> 9. <br /> --- _ ---dunes <br /> 10. <br /> ❑UnItB <br /> Specific Data Range of IMormation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I r <br /> XI UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICL �6'PS IO✓ <br /> �r71f THER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY ❑WASTE TIRE Y� <br /> UNDERGROUND (MONnORINGIREMOYAL)(� ❑DOG KENNEL ❑DAIRY l 3 I% <br /> ,2'RA2ARDOuS WASTE GENERATOR CX ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT L4—q—I z <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOlt PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. Listup to ten addresses addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to to 120914 -0138 or mall to the address indicated above.-0138 or mall to the add�ss 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 behold 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 atthe expense of the applicant <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> Eris USE ONLY <br /> 15' (gf,iavAA <br /> e r <br /> o` <br /> EHD 66.08 Q <br />