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-Sep 09-',310214a URS 4158829261 p.2 <br /> DAfl Vf FE ® • SAN JOAQUIN COUNTY h • EHD LOG NUI✓BER <br /> 57 111 SEP 0 013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> EWRONMEMAL lgone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgcv.crg/ehd <br /> PERMITISERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �rd (tp� On BUSINESS/AGENCY: LES <br /> ADDRESS: r 1 e ( UYI CITYISTATE/ZIP: �ae�FravteiSCS� I CA ')912xl <br /> PHONE (1): H(S p 3'3 Z PHONE (2): FACSIMILE: 1115 - `67,' 9 LGI <br /> TENTATIVE'APPOINTMENT DATE: Time: I2:OOn <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- FEE(CASH R E ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE C?h 13 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS - EHD USE ONLY <br /> "-� Street# Street Name City nit 1 <br /> K� n) <br /> 1. - OO w l <br /> 2. j � A l Sr) 5� sT it2 �7 <br /> 3. l-7'7O f� n�A n.,0 sp + z , <br /> 4. 7 r"` •-VA f1U0:11 <br /> 5. ? <br /> D <br /> 6' Unit4 J <br /> 7. <br /> 8. _0 Units <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From (•.r P C2 <br /> ENVIRONMENT L HEALTH DEPART ENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY OLID WASTE FACILITYNEHICLE UI\,L"1 <br /> 6POTHER CLEANUP SITE(NON-LOP) [ OUSING ABATEMENT �ASTE TIRE l \I F`-D I-) 1'j <br /> NDERGTANK(MONFORINGIREmovAL) ❑FOOD FACILITY AIRY y n C0 <br /> ZAB OVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL WASTEvfATERTREATMENT PLANT <br /> AZARDOUS WASTEHAZARDOUS MATERIALS ❑MOTELIHOTEL POWPER TRUCKIYARDfCHEMI CAL TOILETS <br /> IERED PERMITTED FACILITY POOUSPA &LAND USE APPLICA71ON SITES <br /> ❑TATroolBODY PIERCING liCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 ANI-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above_ Select the typo(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 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 /> 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 /> Future file reviews by the Same applicant may require a$125 deposit prior to review_ —BOXED AREA-EHD USE ONLY'" <br /> .,tJAC�kc '6coo'es c4- Ca Wiz.W fVIC-I(IC _PXLL, 1 SS C- 1191ea- <br /> Received Time' Sep, 9, Iy2013H1.0:.11.A..MONo. 4002StaffName: <br /> EHD 4646`1./s-13 Fav,'Okd (�I,CQJJ Uill ku&alU.r"/ abh(Q f6- �:�4 JMkO)V QMPt 11MMP) SA112 <br />