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From:Marcus H. Bole & Associates 530+633+0119 05/18/2012 10:22 <br />DAT <br />W�JD <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />2012 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�lt1VlR�NME�Av IGF -0- PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />BUSINESSIAGENCY: lSCJI G 1 <br />#239 P.001 <br />EHD LOG NUMBER <br />ADDRESS: 10 t Y U /City/Staate//Zip �� j {(a6a <br />PHONE (1):6 -3c,433 -61I PHONE (2): �30 ! I S "loiA�3 CG) FACSIMILE: � O—(3?—On <br />TENTATIVE" APPOINTMENT DATE: V'9+OAY Wy d J /> �SI�rC Time: j�v V _rlm E <br />(Please allow 10 business days from date of application submittal?"Tentative only - must be confirmed) <br />CHECK BOX TO EXPEDITE REQ T • 5/,1%�05 FEE CAS OR CHECK ONLY) -REQUEST PROCESSED IN 3 B SINES DAYS <br />SIGNATURE OF APPLICANT �t = DATE <br />Electronic Information: ❑ List [] Map — Description: <br />Specific Date Range of Information Requested: From �/ y Ff ug -5 A.5f, , to y <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />WASTE FACILITY/VEWCLE <br />Ig/�*wv <br />OTHER CLEANUP SITE (NON -LOP) ,,j� <br />❑ FOOD FACILITY <br />❑ DOG <br />�S�"O'LID <br />ASTE TIRE <br />❑ DAIRY <br />FILE ADDRESS <br />IQ UNDERGROUND TANK (MONITORING/REMOVAL) V <br />EHD USE ONLY <br />Street# <br />c StreetNamde <br />S, AIS — <br />--�R(Z4,— C��' ""� "` <br />CL o 5 <br />L Q <br />Clty" <br />AY <br />A/ - <br />�f/,, <br />U <br />f D;� rl' <br />N .Ll ,. 4!-; �., <br />_..._- r <br />Unit 3 <br />it a <br />Ivo <br />El Units <br />Gj Unit ti <br />L— <br />TIERED PERMITTED FACILITY <br />13 MOTEL/HOTEL <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />s. <br />-1 <br />4 <br />13 ND USE APPLICATION SITES <br />- <br />Q MEDICAL WASTE FACILITY <br />s. <br />7. <br />- <br />s. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PiH - EXCLUDING HOLIDAYS. <br />9. <br />10. <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 END 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 $105 deposit prior to review. <br />EHD US ONLY <br />5 °I- d '�'t V/ <br />ti <br />tD 4 -O6 8104108 , n /L�t" (�q� /� , n F j � � Ezl�A6 P� {p{ 5fQ .. <br />r-Iz 1-0 vi '�W3� p 1 VCJ ! <br />610 L O.c ompla'("i r;��1�; s 1A 4W �lP, i�r IOS I Sp�rM • cDm%'�yc'U�/1 t} s <br />(Vfb�)T D671 21Iz /It ,nr�. Cc <br />Specific Date Range of Information Requested: From �/ y Ff ug -5 A.5f, , to y <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />WASTE FACILITY/VEWCLE <br />Ig/�*wv <br />OTHER CLEANUP SITE (NON -LOP) ,,j� <br />❑ FOOD FACILITY <br />❑ DOG <br />�S�"O'LID <br />ASTE TIRE <br />❑ DAIRY <br />1 <br />IQ UNDERGROUND TANK (MONITORING/REMOVAL) V <br />KENNEL <br />�/ <br />HAZARDOUS WASTE GENERATOR Gk_ <br />❑ CHICKEN RANCH <br />0 WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />13 MOTEL/HOTEL <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />TATTOO/BODY PIERCING <br />❑ POOUSPA-- <br />//_u"� <br />13 ND USE APPLICATION SITES <br />Q MEDICAL WASTE FACILITY <br />� <br />7 OTHER (PLEASE SPECIFY) <br />j�l[ /- Y>.! "' ' <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PiH - 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 END 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 $105 deposit prior to review. <br />EHD US ONLY <br />5 °I- d '�'t V/ <br />ti <br />tD 4 -O6 8104108 , n /L�t" (�q� /� , n F j � � Ezl�A6 P� {p{ 5fQ .. <br />r-Iz 1-0 vi '�W3� p 1 VCJ ! <br />610 L O.c ompla'("i r;��1�; s 1A 4W �lP, i�r IOS I Sp�rM • cDm%'�yc'U�/1 t} s <br />(Vfb�)T D671 21Iz /It ,nr�. Cc <br />