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■ DAFir" <br /> ECEIVED r ' <br /> ■ �n ,,�T�i� END LOG NUMBER <br /> i E i, a � � SAN JOAQUIN COUN L ,%Ok k <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENT <br /> 41868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 20�lephone: (209)468-3420 Fax. (209)464-0138 Web. www.sjgov-org/ehd <br /> CNV1 <br /> [g0fV1 lfr <br /> "TAL <br /> r �'1 '� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Alf9Rk HAL LAE rr BUSINESS/AGENCY: Jt}i <br /> ADDRESS: S' T ;rd �'� , �`a Z CITY/STATEIZIP: ,(A A Frd,j c 1 s cL9Tq 9 LfIo3 <br /> PHONE(1): PHONE(2): q6 - rl q 97 FACSIMILE:_WS-- <br /> TENTATIVE' <br /> S-TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please ullow.10 business days from data of application submittal--Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH ORE �KONIY) REQUEST PROCESSED IN 3 BUST ES DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: []List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name City []Unit 1 <br /> 2. 0�� <br /> 3. ❑Unit 2 <br /> 4. <br /> 5. _'�-Wit---- --•- -- -.,._ _ � �0 Unit 3 <br /> r7.7' <br /> & 6A �� ys�—0 <br /> 10. x ,13 qo-h <br /> ❑Unit s <br /> SpFclnc Date Range of Information Requestod: From to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT PILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 'SOLID WASTE FACILITY(VEHICL� <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOc3 KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ;KWASTEWATERTREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TATTOOfBODY PIERCING ❑POOL/SPA ❑LANG USE APPLICATION SITES <br /> MEDICAL WASTE FACILRY S�COMPLAINT 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. Eax to(209)464.0138 or mail to the address indicatnd 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 /> z. The EMD 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 some 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 /> Eric w6 ONLY <br /> 11110 46-0a <br /> erlilt <br /> Received Time Sep. 4, 2012 3 :44PM No. 1047 <br />