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ED IF <br /> %/{7'EE19E77 EHO LOG NUMBER <br /> dSAN JOAQUIN COUNTY <br /> SEP 18 2011Q'p ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q I 1:(2 East Hazelton Avenue,Stockton,CA b:www.sigov-org/ehd I <br /> ���W��H �� Telephone:(209)46&3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PFE�u11T/'SFrAY1T`Fa PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (1.1/-44 y -9OJCY $/ BUSINESS/AGENCY: E)2C <br /> ADDRESS: T 9' Ah 'kid CITYISTATEMP: dVaQ-y <br /> PHONE(1): FAX OR E-MAIL: k sl-1 t I FILO <br /> Please allow 10 business days from date of application submittal for the records to be available. dl t/ c(r <br /> Staff will contact you to arrange an appointment date and time to review the requested records. ZATI , <br /> CHECK BOX TO EXPEDITE QUE T-$13 EE(CASH 913 CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the spat b ow. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 /> 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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑List❑ Map—Description: <br /> Specific Date Range of Information Requested: From 1500 to -2,01-1 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> 2V-ERGRG 0TANK NST) Street# Street Name city _ <br /> CIEANI SIZE(LOP) ty /� /� l <br /> 2THERCLeww SNE(Nm-LOP) lSV ( �'� ��Y� ���L ~J�W� 01J% <br /> �HAuwoouswA ne o �ONm. <br /> • f1ERED PE ,,.m FACRRY 2 6 <br /> �AeOYEGRO DTPNK y O� <br /> e$TDM ITORING/P"OVN.) ' L []PWR <br /> Urg—OUSMAWR¢EasEaEaM 3 1// <br /> C]'SnulRm <br /> qD`�sWo WASTE FAaUTYI VSVC <br /> 4 ATe+DDAury <br /> LJ' FACLTry <br /> �PDOE/SPA v SREMmuvn <br /> DAIRY S ry <br /> L D USE FlaPucAnory SMEs <br /> ❑SEPTIC PUMPER TRUCK I How <br /> 6 <br /> YARD/CHENKJJ.TGBET$ <br /> ❑WASTEWATER TxEAWM PUNT CUPA <br /> ❑HOUSNG A6ATEMENT T itw✓ <br /> ❑MGTEUHOm <br /> M CmIX RANCH/DOG KENNEL . CUPA-UsT <br /> ❑MmiO WA FAcI 3 <br /> ❑TATTOOMMY P6:RCNG <br /> DWw E <br /> ❑WASTE TRE <br /> 9 <br /> aCOMFWryT <br /> OIHER(PIFASE SPECIFY): ACCOIMM,4• <br /> 10 <br /> —BOXED AREA-EHD USE ONLY•" <br /> (tom -.(—I 5 u' •ii tRfM•t ✓`. 'l IJ I•n i;� i1u.s1(I .-Mel it'-AD <br /> ❑ Records provided by Staff-PPR Complete- Nome: <br /> EHD 4846 <br />