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u1r uJr 4UlG '1 f::J4 4C)0000 ALL SHIN JUSt <br /> RECEIVED <br /> DATE RECEIVED () EHf?LOG NUMBER <br /> JAN 0 ���� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEAL P 60 0 East Main St. Stockton, CA 95202-3029 <br /> hone: <br /> PERMIT/SERVICES Tele 209 466-3420 Fax: (209) 464-0138 Web: www.sjgov,org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Katie Hindt lI <br /> APPLICANT; BU5INESSIAGENCY: ASI Cola: u1 t r 8 <br /> ADDRESS: 3880 5, Bascom Ave, #z49 CITYISTATEIZIP: San Jose, CA 95124 <br /> F'FfONE(1): 531-295-5725 PHONE(2): FACSIMILE: 408-559-7601 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Phage allow Iia business drays from date of application submittal-•Tontadve only-must be eonflrmedj <br /> LJ CHECK BOX TO EXPEDITE REQUEST,$122 FEE(CASH OR CHECK ONLY)-kf�ECiUEST PROCE'SSr-D IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT khindt@ae i consul'tan.t s.c0MDATE 1-3-12 <br /> ' Electronic Information: ❑ List❑ Map—Description: IT <br /> FILE ADDRESS L !PHO USE ONLY <br /> Street# Street Name CRY <br /> d Uralt f; <br /> 1. 678 N. Wilson .way*'VaA av Stockton <br /> 2. 536-48 Wilson Way* (even ##s) Stockton <br /> 3- ❑unit z <br /> 4. `��D Sq�. <br /> 5. *k'ornte>r1y �'N. East St. " - Unit <br /> 6. <br /> 7 G'I Q q 2— Wil d <br /> 8. <br /> 9, �]Unit 5 <br /> ❑Unit{i <br /> SpactfTc Date Range of Information Requested; From # <br /> ENVIRONMENTAL HEALTH DEPAR MENT FILES <br /> UNDERGROUND TANK(1ST)CLEANUP SITL(LOP) ElHOUSING ABATEMENT <br /> . L3 OTHER CLEANUP SITE(NON•LOP) ❑FOOD TY ❑SOIJD WASTE FACILRYNEHICLE <br /> t ❑ <br /> fl (3 UNDERGROUND TANK(MtpNTrORINGIRI:MOUAL) El L1aG KENNEL <br /> WASTE TIRE <br /> ENNEL ' <br /> C3 HAZARDOUS WASTE GENERATOR ❑IJAIRY <br /> ❑CHICKEN RANCH ❑WASTTREATMENT PLANT <br /> TIERED i}ERMITfED FACILITY [�MOTELMOTEL EWATE:R <br /> ❑TATTOOIBODY PIERCING C�PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> OTHER <br /> ❑ MEDICAL WASTE FACILITY <br /> ❑OTHER <br /> (PLEASE SPECIFY) ❑LAND UsE APPLICATION$rrEs <br /> ❑ (P <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA8LE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING FIOLIDAYS) <br /> 1. Lia to addr sas In the space above. Select the types)of files from the IIsi above by checking the a <br /> box(es). At least one file type MUST be selected. F 2o9 -013 m I the dr�n di Qd ab pproAridress <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END, Applicafions received after <br /> f 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant It any EHD files exist. An appointment for revlew will be carlfirmed approximately ten(10) <br /> ' days after receipt of application. The files will be held for a maximum of five buslness days for review. Appointments <br /> a <br /> Should be-scheduled accordingly. <br /> I 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 /> I submitted when the file is available. <br /> € 4. Any file not returned in the same condition as released will be reorganized by FHD staff at the expense of the applicant. <br /> Future file revieWs by the acme applicant may require a$122 deposit prior to review. <br /> !Nb u8 ONLY ' <br /> t <br /> it <br /> r; -4e-0i <br /> 07!29110 <br /> I. <br />