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rom:Wendy Digiorno Fax:(877)766-6495 To: Fax: +1 (209)464-0138 0^qe 2 of 2 1111812013 11:01 <br /> D � s <br /> �'���� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 1$ 201 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Tele h <br /> rte: (209}468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> ENRONMESrALHEAl <br /> PESMITI <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: U2.y�G'�ct BUSINESS/AGENCY: PGv1' 4/1 amu;p d frc eh <br /> ADDRESS: ZZo I F a4_, ,S C� CITYISTATE/ZIP: Et-R� 5_Fft 2 <br /> PHONE (1 j: 91&-60-&-3330 PHONE(2): FACSIMILE- V.5'S <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �ld Q,fi c�, f�~ DATE (.1/1S// -7 <br /> Electronic Information: ❑ List❑Map— <br /> Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# _ Street Name City ❑Unit 1 <br /> 2. 2,.1.55D ❑Unit 2 <br /> 3, <br /> 4. Q Unit:L <br /> 5. 117 <br /> 6. - - - C( I� _l_ IJ Unit 4 <br /> ad <br /> 7. <br /> $, ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From ft 11 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ®Tf.ERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY [Z COMPLAINT RECORDS ❑'OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAYrFRIDAY 8:00 Am!5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses 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(203)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 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 bescheduled 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 /> EHD USE OZL'Y <br /> EHD 48-06 811111 <br /> Received Time Nov, 18. 2013 11 :02AM No. 4551 <br />