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DATE RECEIVED EMD LPG NUMBER <br /> SAN JOAQUIN COUNTY <br /> Q ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 96202-3029 <br /> 1�1Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> �Roean rT Mcg-� PUBLIC RECORDS RELEASE APPLICATION Copy <br /> APPLICANT: SI Five R re_V�-T BUSINESSIAGENCY: ,p-r4iAr <br /> ADDRESS: OD v '��,� IL/ e. 02. CITY/STATE/ZIP: , a rarL N��ILA <br /> PHONE(1): PHONE(2): l -9/1177..62- FACSIMILE' <br /> TENTATIVE*APPOINTMENT DATE: 13,11-2-11( Time: S e4 <br /> (Please allow 10 business days from date of aPP11cation submittal-`Ten(advo only-must be confirmed) <br /> ❑CHECK 80X TO EXPEDITE REQUEST-$125 FEE(C R PACK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ p DATE <br /> Electronic information: 7 List❑ Map Description, <br /> FILE ADDRESS EHD USE ONLY <br /> street ff Street Name City Uhit 1 <br /> -r4lpur Afrf3 Unit Z <br /> a �� _ r( �/� LL� 1n11�`1�=-SI-KS OVf D A/l s: <br /> 4. <br /> 5. <br /> 6. . C{h Ge.S G) e 1/' Unit 4 <br /> 7. Z,'-'or- ro . 7/ <br /> 8. - otI� <br /> Units <br /> 9. <br /> 10. \ <br /> Unit B <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING AUATEMENT JKSOLID WASTE FACILITYNEHICLE <br /> }�OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ASTE TIRE <br /> )g,UNDERGROUND TANK(MONITORINGIREMOVAL) *DOG KENNEL DAIRY <br /> MHAzARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ,TIERED PERMITTIvb FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARUICHEMICAL TOILETS <br /> ❑TATToo/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY ACOMPLAINT•RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AvAILABLE FOR R F-%qEw. MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDINd HOLIDAYS) <br /> 1. List un to ton ad ftesses 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 mall 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 wili 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 now 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 /> Ngrl 008 ONLY <br /> EHD 48.08 <br /> t{/1/11 <br /> Z0/Z8 39dd ONI -1dH1N3SO2] Z13CN3S b06b8L69% 90:ET TTOZ/T0/ZT <br />