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04/12/2012 12:45 FAX Z001/001 <br /> DATE RECEIVED SAN JOA IN ATT- <br /> RECEIVED <br /> T - EHD LOG NUMBER <br /> R EIV ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> 12 2012 Telephone: (209)468-3420 Fax: (209)464-0138 Web: WWW.Sjgov,org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: `Y`j1 Cly 4�5 EiUSINESS/AGENCY: >✓Arc.� slalrfr'�;bot_ <br /> ADDRESS: A<ye CITYISTATE/ZIP: SN( P,r4 E�Zb, CA9_�2I <br /> PHONE(1): PHONE(2): q(L S —"49 FACSIMILE:1q/6� W-O/6a' <br /> A <br /> TEN TWE'APPOINTMENT DATE' L111 70T Time: 61&t- 1 <br /> (Please allow 10 business days from de of application submittal-•rentatrw only-must be confirmed) <br /> F9 CHECK BOX TO EXPEDITE REQUEST- 5 FE H OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑ Map-Description; <br /> FILE ADDRESS FRO USE ONLY <br /> Street# Threat Name Clry 17 . 1 <br /> 1. Mo S. c--t u�i� v I T <br /> 3. 2boo Cekl L JT — - S7 No 1100 � c� <br /> 4• Z4[O S• E S b4"6-o 57. Stack, Gj unit s <br /> s. L95. F,- t r> vz o Si s'rock-- I`r4 <br /> S. <br /> 171LO S. � DL*J i ST` S`f r_(A�{ unk4 <br /> 7. <br /> El Unit s <br /> 9. <br /> 10. Unk e <br /> Specific Date Ronne of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES g, g <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MoNrrORINCIRLMOVALW— [j DOG KENNEL ❑DAIRYbQ 11LE <br /> HAiARDOUS WASTE GENERATOQ�- C]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT Dir <br /> 1UU <br /> TIERED PERMITTED FACILITY pt- ❑MOTLLIHOTEL E]PUMPER TRUCKlyARD/CHEMICALTO S <br /> TATTOOBODY PIERCING ❑POOUSPA ❑MND USE APPLICATION$RES <br /> MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyiEW: MONDAY-FRIDAY 8:00 AM•S:OOPM(EXCLUDING HOLIDAYS) <br /> f. List up to ten addresses in the space above. Select the type(s)of file*from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. FaX.to_(2091464-0138—0E mall tc the address Indl above. Address <br /> ranges will not be accepted-for additional assistance with Poe addresses,contact the EHD. Appliution6 received atter <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 ten(10) <br /> days 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 /> I Future fila reviews by the same applicant may require a$125 deposit prior to review. <br /> 71 <br /> �f SFO l <br /> i <br /> Omni <br /> EHD re ae <br />