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010/02/2012 TUE 9: 07 FAX 2094682999 SJC Public Works 0001/001 <br /> ■ <br /> j DATE RECEIVED EHD LOG NUMBER <br /> ■ _ ' SAN JOAQUIN COUNTY <br /> ■ Yn ENVIRONMENTAL HEALTH DEPARTMENT <br /> 5 600 East Main St. Stockton, CA 95202-3029 <br /> OCT �l a r�I�Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> NV1gfomFNIAL <br /> I�tv1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /f�� �'( /�fl plfi i���5 BUSINESS/AGENCY:SG Pub I Ave,_45 <br /> ADDRESS: I�fD l� , %(�r_Gf' r� 3 V� CITY/STATEIZIP: <br /> PHONE(1): PHONE(2): ;;�D> FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-,$126 FEE(CASU OR CHECK ONLY)_REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE o{� '� /✓, <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City jUn <br /> 2. / . ��' z In �, :: �3.4. 2 7� � t,� L � ML n . <br /> 5. <br /> 6. l C i%r r� � fUnit4 <br /> 7. <br /> 8. jcJ� !.C I L I✓ ,� <p Unit 5 <br /> 9. <br /> p <br /> 10- j2 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> g,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ZFHOUSING ABATEMENT [RSOLID WASTE FACILITYNEHICLE <br /> ®'OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY WASTE TIRE 4 ( f1/' <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL)/, ❑DOG FENNEL DAIRYjj� II Z <br /> ,©HAZARDOUS WASTE GENERATORY ®CHICKEN RANCH 1:1WASTEV ,tkTREATMENT LAtlT. <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ZI COMPLAINT RECORDS. OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Ann-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 b For C,ddfe5S :*y I.d•& <br /> 2. The EHD will notify the applicant if ar tv will be confirmed approximately ten(10) <br /> days after receipt of application: The To view the ManaMMPgement <br /> (Hazardous ness days for review.Appointments <br /> should be scheduled accordingly. Materials Management Plan)go to the <br /> 3. A file that is actively being worked or following website:www.sjoesdata.org Ible 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 release wi a reorganized Dy tND staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> �iEF e <br /> T VIA <br /> Received Time-00. 2, -2012— 9: 00AM-No, 1261 e�,�„ <br />