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07/03/2012 10:07 FAX 559 442 5081 KL.EINFELDER C1002/002 <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 101&q <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ` '" . t I( tfs BUSINESS/AGENCY: <br /> ADDRESS: 5(25 N, Gaffes Nv'LCITY/STATE2IP; 1✓yQ�YLt�, ��c �3-]aa <br /> PHONE(1): JR 43(Q b��p PHONE (2): 55cl C(LQ (LcoZ FACSIMILE: 60-11 44Z,5cjR/ <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow 10business days from date of appilcation submittal- Tentative onlyTime: <br /> -must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE_fs'�gl zo z <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> City <br /> 1, ❑Unit 1 <br /> n J �'� Ze,���� ,' �-f,���- �' -• ter_ ,�;'.� -p <br /> . � U:.�mit z <br /> 3. �� �r�CT(1lsf1�» J`# <br /> 57 ! I , Unit 3 j <br /> 6 <br /> 7. � �I7 Unit 4 <br /> e W0 <br /> 5 C trt!►i.f 3 %YJ <br /> 9. Unit 5 <br /> �. J <br /> 10. <br /> ❑Unit 8 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACT ljY/VEH1 LE / 7 <br /> r4 OTHER CLEANUP SITE(NON-LOP) F-1FOODFACILITY ❑WASTE TIRE 1-5 I p J [V f" W 1I 7' <br /> _ 2UNDERGROUND TANK(MONITORINC/REMOvAL)01- ❑DOG KENNEL ❑DAIRY 0� qa- iAZARDOUS WASTE GENERATOR '� [:1 CHICKEN RANCH WASTEWATER TREATMENT <br /> -7-1 -,2 <br /> �I <br /> ^❑TIERED PERMIT FACILITY El MOTEL/HOTEL]TATTOOIBODY PIERCING ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS�(+�1, <br /> (`ll MEDICAL WASTE FACILITY ['POOL/SPA F-1LANDUSE APPLICATION SITES <br /> COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> z v WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u to ten addresses in the space above. Select the type(s) of files from the list above b checking the a <br /> box(es). At least one file Y 9 ppropriate q <br /> N type MUST be selected. Fax to(20914t>4-0138 or mail to the address Indicated above Address <br /> S� ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after ^ `•"a <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately <br /> days after receipt of application. The files will be held for a maximum of five business days for reviewAppointments ten(10) <br /> q} should be scheduled accordingly. Y ppointment <br /> ��,73. A file that Is actively being worked on by EHD staff ma no aim ediately available for review. A new application may be t! '� <br /> submitted when the file Is available. q, <br /> 4. Any file not returned in the same condition as tele ed wil b reorganized by EHD staff at the expense o,the applicant. <br /> Future file reviews by the same applicant may re ire a$125 deposit prior to review. <br /> N3-7ft 'le- <br /> C =FD USE <br /> a 7 <br /> Recei-ved Time—Jul, 20 2-11 , 04AM_No. 01217-ll-IZ 0r��73c�S <br /> Mr 1/1 4AL /�,� �lr 3y 3`7 -i�lI- r-25 a„�„ <br />