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EIVEDDAREt +. EHD LOS NUMBER <br /> 1 111.�� SAN JOAQUIN COUNTY L <br /> MAY 2,8 2013 ENVIRONMENTAL HEALTH DEPARTMENT '^/�� <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> Tet Qpp:(209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd f <br /> ENV)RQN tNTlkL. <br /> PESNTIISE 1CES PUBLIC RECORDS RELEASE APPLICAT(ON <br /> APPLICANT: An-to in i-�tU f F1-n a A B SIItNESSIAGENCY: <br /> ADDRESS: �� 1 "�-�. 1fq;ftn4-0:, T "/ "CITY/STATEYZTP: <br /> PHONE(I �Lf7-SGT^ rP�'�`I PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 1D buslness days from date of application submittal-Tentative only-must be confirmed) <br /> ❑ CHECK SOX TO EXPEDITE REOUEST-5125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> S*IRATUREOFAPPUCANT <br /> Electronic Information: [HUst❑Map—Description: _ <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> a 2- ( �._. <br /> 3. <br /> _a7 (YI&r-c1li <br /> __ -G]unit2 <br /> S.501 <br /> S]unh <br /> O <br /> I to /en 0 <br /> it ID I^r 5 . 1, Jva v ' n <br /> 2 4 d.�� bQ/r G rl ❑Unit 6 <br /> Spedfic Date Range of Infortaa86n itequested: From <br /> ENVIRCMNENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACt_TTY ❑SOLID WASTE FACILTTYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NDN-LOP) ❑HOUSING ABATEMENT ❑WA5TETIRE <br /> ❑UNDERGROUND TANK(MONITORING)REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHimum RANCH)DOG KENNEL ❑WASTEYTATBR TREATMENT PLANT <br /> ❑HAZARDOUS WASTEHAZARDOUS MATERIALS ❑MOTEIJHDTEL ❑PUMPER TRUCKIYARDICREMICAL TOILETS <br /> ❑TERM PERMITTED FAVUTY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTDO/BODY NERCING ❑COAIPLANITIRESPON5ER.ECORDS [,�OTHER(PLEASE SPECFY) <br /> WELL AND SEPTIC PERLNT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List ag 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 f209)4G4-0136 or mail to the address ind lcated above. Address <br /> ranges will not be accepted-for additional assistance with ftleaddresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EMD 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 ftle that Is actively being worked on by EHD staff may not be Immediately available for review. A naw application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will be reor'gianlud by EHD staff at the expense of the appNwnl. <br /> Future file reviews by the same applicant may require a 5125 deposit prior to review. tLEBDYEgATfEAi%"fdlSE'f?NdG'1( <br /> P.- <br /> ...� <br /> - <br /> 11 <br /> '�- , f vi V.fix�a b t,• r A 1;41 �f1.I .y ir�1u ..' , G��' �! tl i h #i yla yt. r y v '_. <br /> fWAR <br /> En➢4a•e9 �' eie12 <br /> Received Time May, 28. 2013 8: 12AM No. 3198 <br />