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nc�,cl v cul <br /> JUN 0 7 2011 ubrntbyEmall Print Form <br /> 0 <br /> DATIF RECEIVED SAN JOAQUIN COUNTY <br /> C0nta(ENVIRONMENTAL HEAL <br /> Yvette PERMIT/SERVICES %NVIRONMENTAL HEALTH DEPARTMENT <br /> direct phone 600 East Main St. Stockton, CA 95202-3029 <br /> 209-468-3421 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sjgov.org/ehd <br /> or Cheryl Field PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: o i✓ZZ CX(t S=U BUSINESSIAGENCY; Ac (<T oD si) <br /> ADDRESS: 2$r0U (a ^no 'DCITY/STATE/ZIP: <br /> PHONE(1): (C{2r 1, PHONE(2): -hoc__ FACSIMILE: (2L.n ;-/-LCA- (o 09 9 <br /> TENTATIVE'APPOINTMENT D TE: Time: <br /> (Please allow 10 business d from date of appiiwtlon submittal•'iarrraWe only-mus[be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ S - 15F (GASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 6 I 2,6 11 <br /> Electronic Information: ;Q Lls Map–Description:_V^ P_ 7 Pc r to Q a 2 i c- —S'j i-te. ' T`tok <br /> FILE ADDRESS EHO USE ONLY <br /> Street lr Street Nama city Unh1 <br /> 1 (a00 5?r�Lc (eS Ave, <br /> 2. eo <br /> 3. G 7C1 C✓ Unh2 <br /> 4. g f� JJ II-e—, Unit3 <br /> 6. l� <br /> B Unit 4 <br /> 7. <br /> B clunit 5 <br /> 9. <br /> 10. unit 6 <br /> Specific Date Range of Informatlou Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SaE(LOP) El HOUSING ABATEMENT SOLID WASTE FACILITYNEHIGLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUNDTANK(MONRORING/REMOVAL) [D DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPR LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FORReview: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List uD to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-0136 or mall to the address Indicated above. Address <br /> ranges will not be accepted.for additional assistance with file addresses,contact the EHD. Appl lcations received after <br /> e <br /> 3:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant B any EMD files exist. An appointment for review will be confirmed 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 avallable. <br /> 4. Any file not returned In the same condition as <br /> reorganize <br /> zed re <br /> byED viewtaff at the expense of the applicant. <br /> Future file reviews by the game app may require a 3116 deposit <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468.3425. <br /> EMO e6E ONLY p <br /> eurroa <br /> EHo ae•oe <br /> 12/TB 39tid SINVi-inSNOD I3V 66099t,L9ZG 89:01 ITOZ/L0/90 <br />