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rom:WenDigiomo Fax:(877)7666495 To: 1": +1(209)484-0138 Page 4 of 7 6/17/2013 8:03 <br /> DATE R CEIVED LHU LOG NUMBER <br /> SAN JOAQUIN COUNTY _ <br /> ENVr20NMENTAL HEALTH DEPARTMENT <br /> �� o�. .' w, •w_I <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> T hone: (209)468-3420 Fax: (2,019)464-0138 Web: www.sjgov.org/ehd <br /> Eta ��FI� IBLIC RECORDS RELEASE QPPLICAnON <br /> `ra,�llf rb <br /> APPLICANT: y <(st6t�2D�U BUSINESS/AGENCY: A_ 2" �E�fV(y6r\fvLev�% i trp. <br /> ADDRESS: `M( f}-�.G G0 tJY I �U—) CITYisTATEIziP: 8 �UY6�tiy) Nf6r1 '(Z ICd} e(>( <br /> PHONE(1): 9 ( 6 -606- 3"M PHONE(2): C)((a 450 `0$ FACSIMILE: �'?7- p (O Y'7< <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FE, (CAS, R A(1ECK ONLY)-REQUEST PROCESSED IN'3 B y$IN SS DAYS <br /> SIGNATURE OF APPLICANT DATE / <br /> Electronic Information: ❑ List❑Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> r� Street# Street Name City WWI L/ I.-- Q o D(AAZ 51� Ala(.LAi( + 'Q <br /> 2. )_I(go 0 GJi Unite j <br /> 3. ' to?, r(v <br /> 4, y) roy • • • Unit 3' <br /> 5. 2116 <br /> 6• I(Ep M6 Lin l 3 nit 4 <br /> 7_ <br /> Units <br /> 9. 2 12� a .UD 0 9 <br /> I'I 10. FZunite <br /> Specific Data Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSiNG.ABATEMENT ®SOLID WASTEFACILfTY)VEFYC,LE <br /> .OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY H WASTE TIRE A 7'rW_C5 N+,- <br /> RUNDERGROUND.TANK(MONITORING/REMOVAL ❑DOG KENNEL ❑DAIRY <br /> ©HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH '®WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY;,'< ❑MOTEIIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICALWASTEFAcILrry ®;COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. 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)464-0138 or maifto 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 /> 2. The EHD will notify the applicant if any EHD files oxist. 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 /> future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EM USE ONLY <br /> i <br /> EHD 48-N amiii <br /> Received Time Jun. 12, 2013 8:03AM No. 3377 <br />