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�C VED - ' - EHD LOG NUMBER <br /> DA <br /> SAN JOAQUIN COUT4LE MY <br /> MAY 10 2012 ENVIRONMENTAL HEALTH DEPARTMENT q0q <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Tetephohe: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 'PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Kenne lAn kam I+bn BUSINESS/AGENCY: RIQ2S EywiynnyyY 'X1 <br /> ADDRESS: lyye CITY/STATE/ZIP: ?Vlpe_n 1 -A A-z- A5003 <br /> PHONE(1): &()_2- 7o2S-07()7 PHONE(2): 6CQ-54-111- OGa5 FACSIMILE: &0U2- 728-0702 <br /> TENTATIVE'APPOINTMENT DATE: NR Time: 131\ <br /> (Please allow 10 business days fro date of application ubmittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE ST-$1 5 FE ( ASH 0, ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 172012- <br /> Electronic <br /> 1ZElectronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City ❑Unit 1 <br /> off( 1 70 CAM3ZID -rt2C T ATH2o`�> <br /> 2. ❑Unit 2 <br /> 3. <br /> 4• ❑Unit 3 <br /> 5. <br /> 6• ❑Unit 4 <br /> Z <br /> r8. ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑unit 6 <br /> Speck Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT - ❑SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SHE(NON-LOP) ❑FOOD FACILITY [j WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ElDOG KENNEL ElDAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOOIBOOY PIERCING ❑POOL/SPA ❑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-5:00PM(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 rile not retumed 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> USE O <br /> EMONLY <br /> j V fl Nl� r52 PlM _ <br /> EHD 18.06 completer, <br />