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Jan 26 12 09:51a Dietz 209 833-1288 p.2 <br /> 7R-9WT6jt D .NW 1-0� <br /> I DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> JAN.2,6 RZ2012 <br /> I ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENS T 600 East Main St. Stockton, CA 9.5202-2708 <br /> ASV L <br /> f FE le hone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /Z1 le BUSINESS/AGENCY- _,ble7 Z 6V<?i2 ffC61W57_ IAJC <br /> ADDRESS_ .3 Z 33 �. /moo�%�2 CITY/STATEIZIP: %mac 4' C 5 — To y <br /> PHONE (1): X09 91T Z 776 G PHONE(2):,Z.O 1 5'3Z OVio — FACSIM EIL :201 S.�_3 /28� <br /> TENTATi VE*APPOINTMENT DATE: Ae-t-- 10 / ze: / v Time: /O :ov I*M_ <br /> (Please allow 10 husiness days from date of application submlttal-'Tenlafive only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST,-$115.00 FEE(CASTE OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /, /- K ��4DATE / '// Z— <br /> Electronic Information: ❑ List❑ Map—Description- <br /> FILE ADDRESS END USE ONLY <br /> I Street# Street Name City <br /> L/N/l% <br /> -- -- --- ----------- _ - /2� �7Za <br /> ------ -------- <br /> 2. <br /> --- -.. - -----� --- -- --- - 0 Unit 2 <br /> 3. <br /> 4. <br /> ❑Unit 3 <br /> S —r -- -- - <br /> - <br /> 7. <br /> Unit4 <br /> } <br /> 8. <br /> - --- - ----— -- ---- --�.�. ❑Unit S <br /> 9. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From / r'J to Z0 / U <br /> t ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> 'WOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑$OLID WASTE FACILITYNFHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) WASTE TIRO <br /> ❑DOG KENNEL ❑DAIRY <br /> ALJ HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPUCAT*N SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:DD AM-5:00PM(EXCLUDING HOLIDAYS) <br /> t. List up to ten addresses in the space above. Select the <br /> P 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 flve 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$115.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance lease contact' �1a; 1- r� 7 -- **.. <br /> -- - ----�'— i� �� ��'3`I ,c.,. ,. Thank You <br /> - <br /> ' '-A/�79rno— <br />