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03/18/2013 09:08 53067661", STRATUS ENVIROME7NTAL PAGE 01/01 <br /> +„r <br /> DATE aF-CFFr <br /> EHD LOG NUMBER / <br /> r SAN JOAQUIN COUNTY (nJ_ <br /> ENVIRONMENTAL HEALTH DEPARTN ENT AAA <br /> MAR 18 2011 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: ww.sjgov.org/chd <br /> ENtJj�Nrll1MTAL1GESI+i;_t <br /> PUBLIC RECORDS RELEASE APPLICATION / G <br /> APPLICANT: /�ptia/ ytt t4/Gl( BUSINESSIAGEA ;Y: 54i"4(s r^f/iio t/r7Gcsy�C <br /> ADDRESS: //I': $7`e, SSO CITY/STATEI :IP: _gr°tet F , CIRg56d� <br /> PHONE (1): x'3(3 -4i9d4 PHONE(2): FACSIMILE: <br /> TENTA TIVE'APPOINTM ENT DATE: 2& i•S Time: '77 o d zzr <br /> (Please allow 10 business days from date of application submittal-•Tenfartve mly-must be eonflrmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(GASH OR CHECK ONLY)-REQUEF f PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT : r� DATE <br /> Electronic information: ❑ List❑ Map—Description; <br /> _ FILE ADDRESS EHO USE ONLY <br /> Street 9 Street Name city Unit 1 <br /> El Un <br /> 3. �l(_ <br /> 4• unit 3 / <br /> 6. <br /> _ L7 Unit a <br /> 7. _ <br /> 8• JD units <br /> 10. <br /> ❑Unit 8 <br /> Specific Date Range of Informatlon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE 3 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOUD WASTE FAcTrYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONrroRINGIREMOVAL) ❑DOG KENNEL p DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL p PUMPERTRUCKIYAROICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS p OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8 00 AMS:OOPM(ExCLUDINO HOLIDAYS) <br /> 1. Li_SLup_t0_ton_addresses in the space above. Select the type(s)of flies from the IIsi above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to f2D91464-0138 or mall to It le address Indlppted above, Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact he EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHO will notify the applicant if any EHD files exist An appointment for review ulll be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held fora maximum of five busin ss days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A fife that Is actively being worked on by EHD staff may not be Immediately avallab a for review. A new application may be <br /> submitted when the file is available. <br /> 4- Any flie not returned in the same condition as released will be reorganized by EHD Aa M'at the expense of the applicant. <br /> Future fila reviews by the same applicant may require a$125 deposit prior to reviei <br /> UND I lrF„rMll9 <br /> EHO 4e-0e <br /> eH111 <br /> Received Time Mar. 18. 2013 10: 06AM NO. 2584 <br />