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3 12 03: 03p URS COO 71762021# P . 2 <br /> DATE ® EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY ^ <br /> 6gSAN <br /> ENVIRONMENTAL HEALTH DEPARTMENT , vy <br /> GT LD1? 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> U Telephone: (209) 468-3420 Fax: (209)464-0138 Web: wvvw.sjgov.org/ehd <br /> ENVfftONMES R CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:,I tynq -Ik Sji vi BUSINESS/AGENCY: <✓l�5 (or,'bY C'`�1�T� <br /> ADDRESS: 1-{�b I�f TYDr1"� -S� `jU 1'� L(A>CITY/STATE/ZIP: +((iLf ✓1.5 -+✓! �r'{' 1,111 <br /> PHONE(1): 71 7 UJss--7goL( PHONE (2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: f Time: Cf:p(2jill <br /> (Please allow 1 D business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-.REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑ Map—Description' <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. ❑Unit 2 y <br /> 3. <br /> 4_ — [2 nit3 31 <br /> 5 <br /> 6, i El Unit 4 <br /> I � <br /> T. <br /> B ❑Unit 5 <br /> 9. <br /> ❑unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ONDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) F1 HOUSING A13ATEMENT ❑WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKNARDICHEMICALTOILErs <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT(RESPONSE RECORDS (7 Q'OTHFR(PLEASE SPECIFY)Chts E',1 -('t,LUr'1 <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uv 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 /> ❑ Recdrds provided by Staff-PPR Complete.staff Name: <br /> srata <br /> EHn 4846 <br /> Received Time Oct, 23, 2012 12:06PM No. 1472 <br />