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NOV/22/2011/TUE 11:24 AM DT,j� <br />FAX No, 916266," "� <br />or a'F---M ED <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1)ov 500 East Main St, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/elid <br />ENVIFICaNrAEhiTA . HEAL f 'i <br />r "!c'EPV!GES <br />P. 001/001 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 7v, �r( BUSINESS/AGENCY: Cbr- <br />ADDRESS: `,,`6 C) 0 � SIC �� a� �`�" e CITYrSTATEIZIP: 01-- `r,5 2 <br />PHONE (1): 2-S-5-, --Y7 LC) P H 0 N E (2): _ — FACSIMILE:m3%e% � <br />TENTATIVE' APPOINTMENT DATE:12- <br />J3 j Time: Z>j Onn i700 <br />(Please allow 10 business days from date of appticatio submittal - *Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT T jam• Iry DATE <br />Electronic Information: ❑ List ❑ Map -Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name city Unit 1 <br />1. <br />C� (�, <br />1 r G.a� i2 a <br />pyre rc�, CQ>� �1 u , <br />L C cts-- 1 7 ❑ U n l <br />0 Nu nit3 <br />4. <br />1604 <br />LJ , 4-lv�c� Ivo r e��L7 <br />5. <br />nit A <br />7. <br />Unit 5 <br />8 <br />9. <br />u <br />❑ Unit <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLFANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON•LOP) © FOOD FACILITY ❑ WASTE TIRF <br />UNDERGROUND TANK (MONITORINOIREMOVAL)'O, ❑ UOG KENNEL El DAIRY <br />JK HA7ARDOUS WASTE GENERATOR CHICKEN RANCH ❑ WASTEWATFRTREATMENT PLANT <br />`STiERED PERMITTED FACILITY 1< ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />❑ TATTOOISODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY -FRIDAY 8:00 AM-5:OOPM (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 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 pin 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. <br />4X12, re <br />{_errer) cl govt (,cP tf-w f+ (� fp'✓ �u u '� ;gip©� t �on� Plea n (- . <br />(.0003ial515, 1nHl"L+ AMA-hl-17ill P,lvil�dF,1& <br />