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n 23 2012 1 : 01PM H" _ASERJET FAX p• 2 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 800 East Mein St. Stockton, CA 95202-3029 <br /> _ l one: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ���� •� ` �G� PUBLIC RECORDS RELEASE APPLICATION <br /> APEwTow BUSINESS/AGENCY:_ )CC EijVlppk) #A"L_ <br /> ADD49.'tf�1 <br /> --__��� ��� ST. ��� CfTY/STATElZIP: C�:pklrLo"QC., <br /> PHONE(1); 0) q alb PHONE (2), 1 FACSIMILE: �7DIO ti <br /> TEN7AT(1/E-APPOINTMENT DATE: ( 31 1 2._ Time: 1 t> <br /> (Please allow 10 business from date o applWatlon submltial-'T'ontat/vs only-must be confirmed) <br /> CJ CHECK BOX TO EXPEDIT ES E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 USIN S3 DAYS <br /> SIGNATURE OF APPLICAN UDATE 1 "A .2-- <br /> Electronlc Information: ❑ List ❑ 4up Descriptlow <br /> FILE ADDRESS NLY <br /> Street# 9tr*0 Nem• City Unit 1 <br /> 1. W• Lav C.}C C-ry TV-P L L o <br /> 2• c -5 00 by S`Ls L—cA i unite <br /> 3. <br /> Unit / <br /> lti. Arte, CcA�l� 1 broaa r� /�'i <br /> I��ie Tj�sILCL.OPi� ISI lJnita <br /> 7. l�z�l2 <br /> 8. <br /> units <br /> 0. <br /> unit e <br /> Specfflc Date Rango of Information Raqueatad: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> NDEROROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT LID WASTE FAMLITYNEHICLE <br /> [;401 HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> QM ROROUNDTANK(MONITORINWRENOVAL) ❑Doo KENNEL [I DAIRY <br /> RDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> RED PERMITTED FACILr y ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> [ITATTOOMODY PIERCING ,❑_,, PP LISPA ❑LAND UBE APPLICATIONS ITES <br /> ❑ MEDICAL WASTE FACPrrr [j MPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAEILIE FOR REVIEW: MONDAY•FRIDAY 8:00 Am-6:00PM(EXCLUDINt3 HOLIDAYS) <br /> 1. List up to ton addresses In the space above. Select the type(e)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (204)484.0138 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 EMD will notify the appllcant If any EHD files exlsL An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be hold 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 rsvisws by the same applicant may require a$125 deposit prior to review. <br /> i 12421� 3AT :3e + <br /> e <br /> b <br />