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OCT-16-2013 WED 09:59 AM Moore T ining Associates FAX N0. 559 ?y 7126 P. 02 <br /> JL <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY 1J- ItA� <br /> � <br /> COVE® <br /> ENVIRONMENTAL HEALTH DEPARTMENT ' <br /> OCT 16'2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 o <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: PI. :kT M°`rSr,Le z- BUSINESS/AGENCY: Mcor'e <br /> ADDRESS: 252-7 F,-e-,-,o S+,ee-, CITY/STATE/ZIP: f- GA 137Z'r <br /> PHONE(1): C;1R)' 268 ---vLt PHONE(2):(95�`I) `t'79-175c41 FACSIMILE; CSsa0 7G9-712 6 <br /> TENTATIVE`APPOINTMENT DATE: /o �2 S /� Time: fj•,'-, 4 <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 �� ��'''� ' DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 A' "r <br /> 1. (lot Lever <br /> 2. ili41 t_eBove%�rz S4x,1­4dti .l] Unit2 <br /> 3. <br /> 4. F;C 4,e[__4ar. . Unit 3 <br /> I <br /> 5. 5icct�+vim ���kIL� Ct^i� ( <br /> S. (?LI l✓ur „�{r fZon.2 S-Iocrti>to, 1 lG/z %❑ Unit4 <br /> 7. .S4,d—4 , fin/ CJ/ZY�f 3 <br /> 8. E. F(dF0. ver., e (l S40c`4, ❑units <br /> 9. 701 C '0.r t� S{ree+ l C�-lae k4c..,.N <br /> 10. 1252 1714nit6 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tdUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY d SOLID WASTE FACILITYNEHiCLE <br /> aOTHER CLEANUP SITE(NDN-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> [V�UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY DAIRY <br /> [�ABOVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL RWASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUSMATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICALTOILETS <br /> ul TIERED PERMITTED FACILITY RCOMPLAINTIRESPONSE <br /> POOLISPA [�/ LAND USE APPLICATION SITES <br /> ElTATTOOIBODY PIERCING RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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(2091464-0138 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 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 /> �.F _ _. <br /> Fu ure file reviews by the same applicant may require a$125 deposit prior to review. _ BOX4ARA=E1iR JS`.EQNLY <br /> •Y. <br /> — <br /> ...._ —fir .. _. ..a._. ... .._...... ....... ... ......._. .._....::— — — <br /> 1 .... .. ..................._...-.._....................._............_.....I...._.. - <br /> wz; <br /> .......... <br /> .................. <br /> ...:.........:. <br /> s�tsa:E::iE(::?...........'•. ........... <br /> \ �cgrd. ::pravlddb3(staffpl?R.Cnm.p:. e,:ata......._.... <br /> 9/4112 <br /> �, J6 <br /> ed Time Oct. 16. 2013 9:51AM No, 4318 <br />