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DA IVSD G � HD LOG NUMBER <br /> SAN JOAQUIN COUNTY F <br /> CEIVED ENviRONMENTAL HEALTH DEPARTMENT100 <br /> s�-p 1868 East Hazelton Avenue,e,Stockton, CA 95205-6232© <br /> 4 2OWephone: (209)468-3420 Fax. (209)464-0138 Wei ,.www.Sjgov_Orglehd <br /> ENViRR0NME <br /> NTAL►�is �► L PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: dpi lUBUSINESSIAGENCY:_ 6 6d 1,40 <br /> ADDRESS: S `1" ;,,d ,S-r. 0a.— CITYISTATEIZIP:S �l`A CISea C 9YId. <br /> PHONE(1): S 77'-.5I 2— RHONE(2): 7 L—942- FACSIMILE: <br /> TENTA77VE6APPOINTMENT DATE: Time: <br /> (Pleago aHaw 10 business deys from date of appilcatlon submittal-"Tentative only--must be confirmed) <br /> ❑CHECK I3OX TO EXPEDITE REQUEST.5125 FEE(C SN OR E K ONLY)-REQUEST PROCESSED IN 3 BUST ES DAYS <br /> SIGNATURE OF APPLICANT DATE 4 !� <br /> Ere <br /> Electronic Informatfon: []List❑Map--Description-, <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name city <br /> Unit 1 <br /> A v r�Ac41T L)R_ UPJ <br /> 2_ <br /> ,fire o <br /> unit z YB 3- .� �1 4. Unit3 <br /> 5- <br /> �4 f <br /> 8. M lP'R AL WAk- 0 unit5 <br /> 9. <br /> 10. <br /> 11 Unit 6 <br /> �E -5peciHc Date Range of information Requested: From A I~ G, to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ,� 7 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEMCL�/ <br /> OTHER CLEANUP SITE @ION-LOP) [I FOOD FACILITY JKWASTE TIRE ((�� <br /> UNDERGROUND TANK(MONMORINOIREMOVAL) ❑DOG KENNEL ]DAIRY <br /> HAZARDOUS WASTE OENERATOR ❑CHICKEN RANCH XWASTEWATER TREATMENT PLANT <br /> TIERED PERmiTTED FAcia" ❑MOT ELIHOTEL ❑PumPm TRUCKIYARRICHEMICAL TOILETS <br /> TATTOoIBoOY PiERcimo 0 PoOLiSPA ❑LAND USE APPLtCAl1ON SITES <br /> J� <br /> MEDICAL WASTE FACILITY gCOMPLAINrRECORaS ❑ <br /> OTHER(PLEASE SPECIFY) <br /> WELL AND SEP=PERMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY-FRIDAY 8:00 AM-5:40PM EXCLUDING HoLIDAYs) <br /> 1. List ua to ten addresses in the space above. Select the type(s)of files from the[let above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Egg-to 4209).46A:01 38 or maill to the ad ftse FE4ated above. Address <br /> ranges will not be accepted-for additional asslsfance with file addresses,contact the EHD. Applications mcalved after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHO wild notify tt*applicant if any EHD files exist. An appointment for review will be confirmed approxlmatoly ten(10) <br /> days after receipt of application. The -Eli es will be hold 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 filo is available. <br /> 4. Any file not returned In the some condition as released will be reorganized by E'.HO staff at the expense of the applicant. <br /> Future fele reviews by the some applicant may require a$125 deposit prior to review. <br /> rFID VS6 ONLY <br /> CHD d6-06 <br /> SfJ197 <br /> Received Time Sep, 4. 2012 3:44PM No- 1047 <br />