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DATE RECEIVED tiRSO'ON 011:6 Z106 8�'[nr:i,awil P;AI90;� <br />SAN JOAQUIN Cauly i Y <br />RECEIVED <br />.. <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />'JUL I 2012 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENViFRERMME RV HEALTH <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: M ,1 � �1 )_s ��n BUSINESS/AGENCY: i�'1 e l'S � L= h l/� ��h /y► Q,� r <br />ADDRESS: 1 -15 -of �L�GVC� S� �� CITYISTATEIZIP: lyloAesiD -5- <br />PHONE(1): Ad�--7C, j-_7q6D PHONE (2): FACSIMILE:_-;�0cj%-ZZZ� <br />TEAITATIVE'APPOINTMENT DATE: J'&f,I Time: %o:vO <br />(Please allow 10 business days from date oplica ian submittal -`Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $12 EE (C CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE -411z& <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD, USE ONLY <br />it 1 <br />Street# <br />Street Name <br />City <br />�. <br />/OS <br />S, -_ 1 9 Gcj!�o r`. <br />4� <br />1�2-rpz 4WJ, 7, <br />lj [� _ Unit 2 <br />2. <br />3. <br />Z Unit 3 <br />4. <br />5. <br />[ -fJnit 4 <br />6. <br />7. <br />❑ Units <br />8. <br />9. j <br />❑ Unit <br />10. <br />Specific Date Range of Information Requested: From 'D to ✓,F.S <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />IR�uNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTEF. CI ITYNEHI f - It <br />®'OTHER CLEAN UP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE�C,� (� <br />UNDERGROUND TANK(MONITORING1REMOVAL),,-,4- ❑ DOG KENNEL ❑ DAIRY _Z q_ �yr <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />1�41IERED PERMITTED FACILITI(,,(— ❑ MOTELIHOTEL ❑ PUMPER TRU CKNARDICHEMICAL TOILETS <br />❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERNST RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM -5:00m (EXCLUDING HOLIDAYS) <br />1. List up to ten addresses in the space above. Selectthe 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 conf rmed 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. <br />', � ►< 1L i/ ♦ � . Ir•' ter- / —. � �..�- � r< / lilt �� <br />SM "AASNAININIMUMM <br />EHD 48.06 <br />6'd l,ZZZL9£60Z UOSIGN <br />