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NOV/22/2011/TUE 11 :24 .AM DT" FAX No. 9162556" P. 001/001 <br /> �'�PEC��E SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> t,v/ Z 2 201' 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIR RMIT ENTAL HEALT14 <br /> P <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: C!4 -bT_-S- C, <br /> K <br /> ADDRESS: 06`600 T)rNN1L CITY/STATE/ZIP; S�_C_ TTR2.�, <br /> PHONE(1): _j_L6 6 • 2-5-5-_J)7 LK) PHONE(2): FACSIMILE: .g 3L9.L <br /> TENTATIVE`APPOINTMENT DATE' t 13 i,� Time: z:)iKoc) -('700 <br /> (Please allow 10 business days from date of applieatia submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR PHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT j e� V�h 3(<1sJ DATE <br /> Electronic Information: ❑List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street fi Street Name City rTj Unit <br /> 1. -7f. �. ( �r to rl 120 FYer c� Cnt D r <br /> �, ah um 2. )yoo (� 0 <br /> 3. Lit{ 4 -7 'r or'�" l.: SirO C_t O 1A W <br /> 0 fyo nst3 <br /> 5. <br /> 6. . nH 4 <br /> Z <br /> $, ugh:5 <br /> 9. <br /> 10. O Unit s <br /> specific Data Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ' 'AUNDERGROUND TANK(UST)CLEANUP SR>_(LOP) El HOUSING ABATEMENT SOLID WASTE FACILRYNEHICLE II <br /> OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY H WAs1E TIRE U,'I 1 T 3 <br /> UNDERGROUND TANK(MONRORINeIREMWAL) ❑DOG KENNEL ❑DAIRY I Z.-54 <br /> HAZARDOUS WASTE GENERATOR O( ❑CHICKEN RANCH ❑WASTEWATERTREATMENT PLANT <br /> TIERED PERMITTED FACILITY O, ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LANG USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 21COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyIEw: 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(as). At least one file type MUST be selected. Fax to(209)484.0138 or mall 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 retumad 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$925 deposit prior to review. <br /> .(( PrNE �-. <br /> i '11 '• 'L 6II IZ- II e ISS <br /> 0I 3 s co0o 024L5 <br /> ENDaa.o A')/' ©I—t 60 err++ <br /> o.n-e i n d� ref�erf�ec! d7°ov►-(.tP rFrn1 fi•l�{o•qu w� P M Aua�F .�- <br /> Co <br />