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06/14/2012 THU 10: 59 FAX 301251,0242 The Humane Society WjVV/1 VV4 <br /> "N <br /> EHD LOG NUMBER <br /> F1 <br /> DATE 111EjVV1 <br /> SAN JOAQUIN COUNTY <br /> EC__ ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 7o <br /> j'; 1 4 2-012 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd 03& <br /> FINVIRONMENTAL HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY:_ <br /> ADDRESS: ON CITYISTAT EIZIP:•Vu4je' <br /> PHONE(1): t(Q- ? PHONE 0 N E(2) FACSIMILE- <br /> TENTATIVE*APPOINTMENT DATE: 7E. <br /> 7— <br /> Time:(Please allow 10 business days from date of appliodVion'submittal-*Tenraflye o -must be confirmed) <br /> e <br /> FICHECK BOX TO EXPEDITE REQUEST,-w EE(CA�31­1 OR CI­19.19�,K, ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> Y1 -T* I,' —" "*—/ <br /> SIGNATURE OF APPLICANT' DATE <br /> Electronic Information. Ej List 0 Map-Description: <br /> FEE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 Unit I <br /> .................... ........ <br /> 2. Unit 2 <br /> 3. ...... ................................ <br /> 4. <br /> ................:Z' <br /> rZ1 <br /> UnIt4 <br /> 7. <br /> El Unit 5 1 <br /> 0 Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILETS <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 'El HOUSING ABATEmrNT E]SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP): Q FOOD FACILITY ❑WASTE TIRE <br /> [:].UNDERGROUND TANK(MONITORIN(.)/REMOVA.L) 0 DOG KENNEL ❑DAIRY <br /> n HAZARDOUS WASTE GENERATOR X'__,CHICKEN RANCH Cl WASTEWATER TRFAT14ENT PLANT <br /> ❑ R <br /> TIERED PERMITTED FACILITY - MOTELIHOTEL ❑PUMPER TRUCKIYARO/CHENlicAL TOILETS <br /> ❑TATTQOIBODY PIERCING F]POOLISPA El LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND-SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00.AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses InAhe 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(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact th6*EHD. Applications received after <br /> 3:00 pm will be procesped the next business day. <br /> 2. The EHD will notify the applicant if any E14D files exist. An appointment for review will be confirmed approximately ten(10) <br /> (lays 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 /> Future file reviews by the-same applicant may require a$125 deposit prior to review, <br /> EHD USE ONLY <br /> EHD 48-06 811/11 <br /> Received Time Jun. 14. 2012 8:02AM No, 0219 <br />