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Sep 09 13 10:24a URS 4158829261 p.2 <br /> DAiR VE ® SAN JOAQUIN COUNTY y EHD LOG NUMBER <br /> ,� `� <br /> SEP d� 2013IVF ENVIRONMENTAL HEALTH DEPARTMENT it <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> EWR0�4MIFNTAL (lone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.crglehd q141 <br /> pERMTTfSEFMCES <br /> PPUBLIC RECORDS RELEASE APPLICATION FIL E <br /> I � <br /> APPLICANT: tt SUSINESSIAGENCY: ���'y <br /> ADDRESS: a CITYISTATE(ZIP: Sk({Gnc�5Cc� i C�. g�il�{ <br /> PHONE(1): X11'5-2�13�3 2 <br /> PHONE (2): FACSIMILE: X115 — M?,— 91Li <br /> TENTATIVE"APPOINTMENT DATE: p Time: i 2;Corw- <br /> {Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- FEE(CASH R E ONLY)-REQUEST PROCESSED IN 3 BUSIINES/S DAYS <br /> SIGNATURE OF APPLICANT `/f-' DATE Q 1 9l j3 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City .-ET-10-nit 1 t <br /> k <br /> 00 1.J t LL c 1710 ll 7 lnJ `�(' v� to , nit 3 <br /> 5. <br /> o) <br /> � <br /> Unit 4 J <br /> 6 <br /> 7. <br /> 8• _121"U;nit 5 <br /> 9. � <br /> �� I <br /> 10. ,pTlnit 6 <br /> Specific Date Range of Information Requested: From r`reaoQ �- c2 <br /> ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> [� NDERGROUND TANK(UST)CLEANUP SITE(LOP) EDICAL WASTE FACILITY OLID WASTE FAC(LffYNEHICLE r0 <br /> ,ETHER CLEANUP SITE(NON-LOP) <br /> ENVIRONMENT <br /> ABATEMENT ASTE TIRE }+ <br /> NDERGROUND TANK(MONITO RI NGI REMOVAL) ❑FOOD FACILITY rAIRY <br /> BDVEGROUNDTANK [71 CHICKEN RANC}ilDOG KENNEL ASTEWATERTREATMENT PLANT <br /> ✓ H RDOUSWASTE(HAZARDOUSMATERIALS ❑MOTELIHOTEL VIPER TRU CKIYARDICHEMI CAL TOILETS <br /> QTIERED PERMfTTED FACILITY ❑POOLtSPAAND USE APPLICATION SITES <br /> ❑TATToolBODY PIERCING ff cOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND 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(209)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$125 deposit prior to review. "-BOXED AREA-EHD USE ONLY" <br /> Received Time"cSep, 9. 'y2013fi10: 1IAMDNo. 4002Staff Name: <br /> EHD 48-06 914112 <br />