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11/19/2012 14:45 91664866 p ADR . PAGE 02/02 <br /> .�G3 EHD LOG NUMBER <br /> REEPU v ® <br /> SAN ENVIRONMENTAL <br /> HE N COUNTY <br /> ��'"'"'[[ ENVIRONMENTAL FIEALTN DEPARTMENT <br /> NOV 19 20121868 East Hazelton Avenue, Stockton, CA 95205-6232 f <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH �G <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t <br /> ht3 ells 1" SUSINESSIAGENCY: .A <br /> _ <br /> ADDRESS: /�� � �iCl� r" - "tZdL _ CITYISTATEIZIP:SIMb.d/Yl.!%nfY GQ pIS r6 <br /> PHONE(1)t �)�6 �'�127 -�L f,° PHONFr FACSIMILE:71}r — '{1� /,QB <br /> TENTATIVE*APPOINTMENT DATE: t\ �� -ZO I�2- Time: <br /> (aleasoollow10 buelnesa days from da afapplioatlon cubmlttel- Tenfamvoonly•Pwst bacon rmad) <br /> �CHECK BOX-TO EXPEDITE RE VEST-6`125F (CASH OR CHECK ONLY)-REQUEST PROCESSEDIN3 USIN SDAYS <br /> GN <br /> SIATURE OF APPLICANT ; 4�'-�-Q DATE It `1 12_012_ <br /> Electronic information- ❑List❑Map—Description:_ <br /> FILE ADDRESS EHD UsE ONLY <br /> 3lreel@ 5lreat Name city O,Unit 1 <br /> 1, I`L IrJES punit2 <br /> 2. I Z <br /> 3, t 1 b c <br /> ❑ <br /> 4, rJ units It <br /> 5. <br /> 5 Elunit 4 <br /> 7, <br /> []unit a <br /> B. <br /> 9. <br /> ❑Unit S <br /> 10, <br /> Speolfla Data Renee of information Requested: From f to YSc1.IT <br /> ENVIRONMENTALHEALTH EPARTMENTFILEa SoLtD WASTE FACIUrYNEHICLS <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOusING ASATWENT dVAGTETIRE <br /> OTHER CLEANUP SITE(NON•L0P) <br /> FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMONAL) ❑DOG KENNEL El DAIRY <br /> HA7"0I1SWASTE G ENERATOR El CHICKEN RANCH TIERED <br /> WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ LI <br /> MOTELiHOTEL PUMPER TRUCKIYARDICHEMIUALTOILETS <br /> TATTOOIBODY PIERCING ❑POOL/SPA F]LAND USE APPLICATION SITEa <br /> 10 MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVATLA9LE FOR REVIEW: MONDAY-FRIDAY S:oO AM*00 PM(EXCLUDING HOLIDAYS) <br /> 1, List up to ten addresses in the apace above. Select the o pe($)09 f f0is iles from'18 or mth tistF a addret above ss eckingthe ah oyeroppriiatt ess <br /> Fox(es). At least one hie type MUST be selected. F.— <br /> ranges will not be accepted-for addltionat assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day, <br /> 2, The EHR will noilfy the applicant if any EHD files exist. An appointment for revlew will be confirmed approximately ten(110) <br /> days after receipt of appRcadon. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. Afile that is aotb ely being worked on by RHD staff may not be Immedlataly available for review. A now application may be <br /> submitted when the fire Is available. <br /> a, Any file,not returned In the same condition ae releassd 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 /> ENo ueacn r <br /> vu <br /> EHD 48-00 <br /> Received Time Plav, 19. 2012 2: 31PM PIo. 1664 <br />