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BUSINESS/AGENCY:
<br />CITY/STATE/ZIP: ,. d-il- 3ase/- (A- qstlz-
<br />PHONE (1): gob) (polo - qiil PHONE (2): C/2-(!) 2 ,99--9 0 /S FACSIMILECIO 3/ 6-C22-0a
<br />TE ATIVE" APPOINTMENT DATE: ji,WS ci, 19-Vir4S-1- j7 Time: -t" 041
<br />(Please allow 10 business days from date of applicgion submittal - 'Tentative only - must be confirmed)
<br />1=1 CHECK BOX TO EXPEDITE REtilktidW - $125 (C , SH P fC H ECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS
<br />cI(aMTIIPFflFAPPLICANT DATE 160113
<br />c ,
<br />APPLICANT: Sox-a
<br />ADDRESS; 169 N AflY5'{' _54114,47 51-1 -20 )
<br />No. 0027 P. 2_ Ehj LsiL, NUMBER
<br />SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />AUG 13 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vvww.sjgov.orgiehd
<br />ENVIRONMENTAL HEALTH
<br />PERMITISEFMCES PUBLIC RECORDS RELEASE APPLICATION
<br />ug:_13. 2013 4:28PM
<br />RECEIVED
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<br />Electronic Information: El List ap -Description: vaitAiva Toy-t-16-, 04 artu I-1 a gemi 4.104 .-tperbj
<br />FILE ADDRESS
<br />END USE ONLY
<br />II Unit 1 Street # Street Name City
<br />I:Awn'.
<br />7,7,0 1
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<br />, Unit 2
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<br />3: 100 if 11141,14riiiV-L 1 Ov-, -i-z2t Ki-n-, 2—ctic,,- .
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<br />ik — ---., k$ M- ._ A .1.4 Ve./ li t-
<br />Specific Date Range of Informs Requested: _ From
<br />" --- ENVIRONMENTAL HEALTH DEPARTMENT PIES
<br />II 'UNDERGROUND TANK (UST) CLEANUP SITE (LOP) EDICAL WASTE FACILITY [lt/SOLID WASTE FACILITYNEHICLE
<br />[ZOTHER CLEANUP SITE (Nori•LOP) El HOUSING ABATEMENT i WASTE TIRE
<br />.1:31)NDERGROUND TANK (MONITORING1REMOVAL) 0 rooD FACILITY DAIRY
<br />&ABOVEGROUND TANK 0 CHICKEN RANCH/ DOG KENNEL in WASTEWATER TREATMENT PLANT
<br />ETIERED PERMITTED FACILITY
<br />AZARDOUS WASTE/HAZARDOUS MATERIALS D MOTELIHOTEL
<br />Li POOL/SPA
<br />1-_11LIMPERTRUCKIYARD/CHEMICAL TOILETS
<br />E{AND USE APPLICATION SITES
<br />0 TATTOO/BODY PIERCING OCOMPLAINTIRESPONSE RECORDS El OTHER (PLEASE SPECIFY)
<br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FR1DAY 8:00 Am-5:00pm (EXCLUDING HOLIDAYS)
<br />List up to ten addresses in the 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) 464-0136 or mail to the address Indicated above. Address
<br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after
<br />3:00 pm will be processed the next business day.
<br />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 />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 />Any file not returned in the same condition as released will be reorganized by END staff at the eXense of the applicant.
<br />
<br />ulre a $125 deposit prior to reviel.v. HP_Wcg
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<br />Name 914112 U , Records. provided by Staff-PPR: Complete. Staff
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