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May. 23, 2013 4:47PM No. 3205 P. 2 <br /> b 4k <br /> t iicsl�d <br /> c '^JAN 4L&N � EHD[.OG NuMgE <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: JO..t BUSINE=SS/AGENCY: �u1` La, lTl^I►t <br /> ADDRESS: 10(4Tfl, CITY/STATE21r: <br /> PHONE(1): IL�C'02,',?&0 eg+ PHONE(2): FACSIMILE: g1l <br /> TENTATIVE*APPOINTMENT DATE: Time,, <br /> (Please allow 10 business days from date of application submittal-°Tentative only-murk be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE_$1 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �2c (1' <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streak 0 Street Name City 0Unit 1 <br /> F21. t� <br /> , 5 _ ❑Unit 2 <br /> 3. <br /> 4. Unit Jl� <br /> 5. <br /> S- �Unit4 <br /> 7. <br /> 8. n Unit 5 <br /> 10. i <br /> 19" <br /> Specific Date Range of Information Requested: From 042Z/to <br /> to P <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 M1=D(CAL WASTE FACILITY ❑SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ oUsING ABATEMENT E]WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) FOola FACILITY ❑DAIRY <br /> ABOVEGROUND TANK [CHICKEN RANCH/DDG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE(HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITYwCoMPLAINTIRESPONSE <br /> OOLISPA ❑LAND USE APPLICATION SITES <br /> F1TATToolBoDY PIERCING RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL ANDSEPTIC PERMIT RF-CORDS ARE AVAII-ABLE)=OR REVIEW: MoNIDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the typo(s)of files from the list 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 he accepted-for additional assistance with file addresses,contact the EHD. Appllcatloris received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHb 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 flies 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 /> "'`fir_'?c_:;��::';i��'"��a°;�y�s•_:�:�' •'�'%:i:����;.�•: <br /> ::� ;- ,� • ,. ( F?ta.<K ,i yds:�i'=': <br /> .:��':{o�.ry 'f iY •'Y,v .:N. '!g� .f.-°3°+'i. ��i', <br /> :.:4•: •'.FSS:.'.i7:��:�.'� �_^�.R�"., �..fl:•.a. •",y �: jc*" ...,:.(..•t <br /> p>Recor.':s�'C.ol�lcJeR[Z Cod Int :Sra4f:Name: �, _ <br /> EMD 48.06 914112 <br /> Received Time May. 23. 2013 2:43PM No, 3177 <br />