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�t291�9: 7a AECOMo _ 1-831-655-3037 p,1 <br /> –REC <br /> ATE E !7 ED SAN JOAQUIN COUNTY � EHD LOG NUnnBEg,�� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 2 9 2012 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vwwv.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t 1`�-tai f��t + t BUSINESS/AGENCY: zYs �fi <br /> ADDRESS: CITYIS TATE/ZIP: <br /> PHONE (1): (®_9t��/-/7—�f 2 wri�ar�e (2f: �g�- 7� FACSIMILE: <br /> TEVTATIV '`APPOINTMENT DATE: Time: — <br /> (Please alloy 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK SOX TO EXPEDITE REQUEST- 125 FEE(CASH ORCHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � �����Z _ DATE 61 6Aj or-jr Zq,2ol <br /> Electronic Information: ❑ List❑ Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2, O ❑ Unit 2 <br /> 3. <br /> I " <br /> 4. <br /> _I] Unit:3 <br /> L /n_it 4 <br /> 7. <br /> f ❑Unit 5 <br /> 10. I ---- — p Unit s <br /> Specific Date Range of information Requested: From vA fc-L <br /> EWARONMENTAL HEALTH DEPARTMENT FILES <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FAC€LITYIVEHICLE <br /> OTHER CLEANUP SITE((SON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MON ITORDNG(REFAOVAL) ❑FOOD FACILITY ❑DAIRY <br /> []ABOVEGROUND TANK ❑CHICKEN RANCH[DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 0 HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL <br /> [� PERMITTED FACILITY E]PUMPER TRUCKIYARDICHEM€CAL TOILETS <br /> TIERED PER <br /> ❑POOLISPA ❑LAND USE APPLICATION STIES <br /> ❑TATT00(SODY PIERCING [A COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:040 Ain-5:00PM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files;from the fist 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 EHE}files exist. Ars appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The fifes 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$125 deposit prior to review. ' *I30XE€3 ARBA�EFf ;TJiSE04L ! <br /> ..:..:..:. <br /> .....t(.... ...: .: - - - <br /> a: <br /> IRS <br /> t <br /> .: rr <br /> .,• .=i Vii:::.'.•.:t,., ....,..::.. <br /> .._...�,.....moi'.,. <br /> i <br /> 1=7Ui <br /> Records.prrsvitid byta#f;F'PR_ ornp{ate statf�tarne: <br /> EReceived Time—Uctr 29. -2012— 9: 17AN1—No. 150$ 914712 <br />