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Iti 11/07/2012 13:27 80523993- SIERRA DELTA COt'- "_T PAGE 01/01 <br /> 114 <br /> nr.:GEJ\/ED/ <br /> Y EHD LOG NUMBER <br /> FM SAN JOAQUIN COUNTY <br /> NOV Q 7 zolz ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton. CA 95205-6232 <br /> ENVIRONMENTALHffi0ohone: (209)468.3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> pERMITISERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��G C�z i L�.G'Ce u� BUSINESS/AGENCY: <br /> ADDRESS: `f�S`" N• ��57"y v& CITYISTATEIZIP; � <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: q/11 19 I?- _ Time: <br /> (Ploase anow 10 business days from data 01&POICAtion subm(ttal-`Tenfalim only-must be cortfinnod) <br /> ❑CHECK SOX TO EXPEDITE REQUEST.$125 FEL( CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT� DATE ill; /7— <br /> rElleamnic <br /> Z— <br /> Eleamnic Information: ❑List❑ Map-.Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stnest Stmt Nan* <br /> City El unit1 <br /> 2. r4P000 _UunR2 <br /> unirt 3 <br /> 4. <br /> 6. (If Unit 4 <br /> 7. _ <br /> Unit 5 <br /> Eli] [3 <br /> S. <br /> 10. unit B <br /> Y <br /> Specific Uaw Range of tnbormatilon Raqueatad: From doe e /V to gs <br /> EWRONMENTAL HEALTH DEPARTMENT FILE <br /> UNDERGROUND TANK(UM CLEANUP SITE(LOP) ❑MEDICAL WAS'1E FACLTTY ❑SOLID WARTS FACiLnIVEHICLE <br /> IOTHER CLEANUP SITE(NON-LOP) ❑HOUSM6 AgATEMSNT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONRORNGIREmovAL) ❑FOOD FACILITY ❑DAIRY <br /> ABWGROUNOTANK ❑CHICKEN RANGY DOG KENNET. ❑WAsmwATER TREATMENT PLANT <br /> 21 Hvmwu8WASTEfHAVAMUSMAtERIALS ❑MOIEUHOTEL ❑PUMPER TRUCKNARDICHEMICALTOLFiS <br /> ❑TIERM PFRMRTHD FACILITY []POOUSPA ❑LAND USE APPI.ICATtON SITES <br /> ❑TATTOOMODY PIERCING CoMPLAiwTIRi;sPoNSE RECORDS []OTHER(hWE SYE413FY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVPJL.A13LE FOR REVIEW: MONDAY-FRIDAY 8:01D AM-5:00rM(EXCLUDING HOUOAYS) <br /> 1. List' to Egn address e$In the space above. Select the type(:) G files from the Ilst above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Eax to(209)464.0138 or mlatl R address Indkated-above._ Address <br /> ranges will not be accepted-for additional assistance with file addresses:,contact the EHD. Appilcailon3 received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD flies exist. An appointment for review wiN be confirmed approximately ten(10) <br /> days.after recelpt of application. The fikm will be held for a,maximum of five business days for review. Appoiraments <br /> .should be scheduled accordingly. <br /> 3. A file that is actNely b®ing worked on EHD staff►ngy►not be Immediately avanable for review. Anew application maybe <br /> suhmXted when the file is available- <br /> ..4, <br /> vailable.•4. Any file not rsturned in the same eondWon as released Will be reorgardzed by EHD staff at the expsnse of file appikarTL <br /> Future fila reviews by the same applicant may require a$125 deposit prior to review. -'WXED AREA-EHD USE ONLY <br /> Records provided by Staff-PPR Complete.statPName: _ <br /> ovM+s <br /> Received Time Nov. 7. 2012 12: 29PM No- 1573 <br />