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■ 01/22/2013 10:48 9254260106 BUREAU VERITAS PAGE 01 <br /> ■ `� EHD LOG NUMBER <br /> ■ DATE RECEIA��/�+Fv SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT O <br /> 4: 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> phone: (209) 468-3420 Fax: (209)464-0138 Web: www-sjgov.Or9/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:��g�� kear� / BUSlNE53lAGENCY: NLS V <br /> C I-iY/STATF_/Zl P: � <br /> ADDRESS: / <br /> G yryg--(�—?,p <br /> PHONE (2):l FACSIMILE: <br /> PHONE(1): ��� <br /> TENTATlVE"APPOINTMENT DATE' Time: <br /> (Please allow 10 buslness days from date of application submittal--TertfatJva only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125.FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List 0 Map—Descrip lon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City ❑ Unit i <br /> _ -T <br /> F2, <br /> �'2kt-ka)45,En r <br /> -p unite <br /> i <br /> 4. Z Unit 3 <br /> 5. � vCi a <br /> 6- ❑Unit 4 <br /> 7. <br /> 8. I ❑ Unit 5 <br /> 9. <br /> 10. ,E]Unite <br /> Specific Data Range of Information Requested, From to <br /> Al I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> C OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT RWASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ZI WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WAVEIHAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REview: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1. List ug to ten addresses in the space above. Select the type(s)of files from the Ilst above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to!2091464.0138 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 notif} 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 ex ense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. a � <br /> Miamiyl <br /> .I <br /> .. ,. :. <br /> EHD 46-08 91'u�Z <br /> Received Time Jan. 22. 2013 10:46AM No, 2136 <br />