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11/19/,2012 14:45 91664866 ADR PAGE 01/02 <br /> 1 Is <br /> DATE RECEIVED EHD LOO NUMBER re <br /> RECEIVED SAN JOAQUIN COUNTY �jp.p -ttyVN0ra,A}(II4/14 �� <br /> ENVIRONMENTAL HEALTH DEPARTMENT U I\(lvt- fZ l ES --_S:Cj_ <br /> NOV 19 2012 1868 East Hazelton Avenue, Stockton, CA 95205-6232 � 1& ri•.' /J CP y4 k,V 1 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.eigov.org/ehd <br /> C <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: fJt�)S k41�10Sp� BUSINESS/AGENCY: ylP_." A4*TM1- <br /> .ADDRESS: L?-'? �i[Z CT• Zf72 CITY/STATEfZIP:S�AU',, 6 <br /> PHONE(1): 72)-69P HON Ib-LI(i —36Q _ FACSIMILE:91b <br /> TENTATIVE*APPOINTMENT DATE: 1N Time: <br /> (Please allow 10 business days ttom tla11,3 of application submittal•'Tentative oniy.mLtat Do conflrmed) <br /> CHECK BOX 70 EXPEDITERE UEST-$125 FF�(CASHH OR CHECK ONLY)-REQUEST PROCESSED INS USINE SDAYS <br /> SIGNATUREOFAPPLICANT� DATE It �19 2 <br /> Electronic information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Natne CILY ❑Unit 1 <br /> 2, , WL <br /> ❑Unit 2 <br /> 3. ZL{4. )� l6, 22/L SIQQL� fit H6014 <br /> 7• 2 52. I Fi t c deer la)x e <br /> S. $ CA-(L) It a-1 ❑unit s <br /> g. 1 <br /> 10, ASO,,p 6 �O�Jr r^e� <br /> - nits <br /> Spaolflo Date Range of Ih(ormallon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> (�UNDERGitOUN O TANK(UST)CLF%NUP SITE(LOP) ❑HOUSING ABATEMENT JZSOLID WASTE FACILITYNENICLE <br /> OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY WASTETIRE <br /> UWERORomo TANK(MONFIDRMOIRFMOVAL) '❑OoGKENNEL DAIRY <br /> HAwDOuSWASTR GENERATOR ❑CHIcKENRANCH ❑WAsTewATERTREATmiNr PLANT <br /> ®TIERED PERMITTED FACILITY ❑MOTEUHDTEL ❑PUMPERTRUOWYARDICNEMICALTOILETS <br /> ❑TATTOWBODY PIERCING ❑POOUSPA ❑LANG USE APPLICATION SITES <br /> 5d MEDICALWASTEFAOILfTY W CON PLAINT Rer OROS ❑OTHER(PLEASE SPECOY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY•FRIoAY 8:00 AM•5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. <br /> List uetoten addresses It,the space above. Select The fype(s)offlfasfromthe list above bycheckingtheappropriate <br /> box(es). At least one Elle type MUST be selected. Fav r rgOet 404-D1sa or mall to the address Indleated above._ Address <br /> ranges will not be accepted-for additional a4slstanco with file addresses,contaol the EHU. AppllCRATonereceivedAfter <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 1s actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file to available. <br /> a, Any Nle not returned In lha'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, <br /> ( 3042- <br /> Received <br /> CT 'Received Time Nov, 14. 2012 2:31PM No. 1664 I <br />