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•t291 /a AECOMo 1-831-655-3037 p.1 r"A"ECi EIVED EHD LOG IJUMB � � SAN .IC?AQl19N COUNTY � ENVIRONMENTAL HEALTH DEPARTMENT OCT 29 2012 1868 East Hazelton Avenue, Stockton, CA 95205-6232 , 1` Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vwvw.sjgov.org/ehd EWRONMENTALHEALTH PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION r APPLICANT: klfx` -'7J --eft "rcr t� BUSINESS/AGENCY: Aaohv ADDRESS: I �) J Ale1V10T Azrlxo CITY/STATE/ZIP: C qx A-f2.1 L.Gp (?A- t}3s/Z PHONE(1): (f3t)71/7-0yt6Z PHONE (2): )3?9'- 3775— FACSIMILE: TENTATIV 'APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) ❑CHECK BOX TO EXPEDITE REQUEST-j%125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE MsA,r OCI- 29,20/2 Electronic Information: ❑ List❑ Map— Description: FILE ADDRESS EHD USE ONLY Street# Street Name City _ 0 Uni tA 1. q5q3It4l"z6thaM 5 GAJ , bl 5 I dDt6 2. 3. ❑Unit 2 4. Unit 3 Y 5. 6. Unit4 7. 8. Unit 5 9.' 10. ❑Unit 6 Specific Date Range of Information Requested: From {tne LA. A—L-(. . ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE!!� OTHER CLEANUP SITE(NON-LOP) ElFi HOUSING ABATEMENT ❑WASTE TIRE !) 'e$ ]n/UA(t3. UNDERGROUND TANK(MONITOR(NGIREMOVAL)17�- ❑FOOD FACILITY ❑DAIRY ,/ a yl�� m ABOVEGROUND TANK(' ❑CHICKEN RANCHI DOG KENNEL SEA ENT LANT f F.rl Z HAZARDOUS WASTEIHAZARDOUS MATERIALS Ci ❑MOTEUHOTEL ❑PUMPER TRUCK A EAT ICAL TIERED PERMITTED FACILITY 0< ❑❑PUMPER TRU6KICATION SITES TOILETS ❑POOLISPA LAND USE APPLICATION SITES ❑TATTOOMODY PIERCING ®COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REy1EW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant Future file reviews by the same applicant may require a$125 deposit prior to review. *W~,..�, 0)Xt9„! _); ,tttl .Kir:, 44 1 T� M1 •• �rj � r �s�! � - �� r�J"� .^J/J' � r�r Jlr* fl F', r+l P J: I '. .r�iJ•Yf r'�fr. A t �r ar 1e r r�. r Yf )v�'iwf 5r7 4 +, trtl s . -t'T�hi'£' lr`�,;:. y'irv• �.Jfur rr✓�fr ;1 }< 7i ry� ry r •1. J } . 'hJ' Jvr .•:..y,.:.,'sc;a;$r;....:,;;y. ,.�,.,.,rt :x.,:.r.a•-,..`. -:q.r w.t�5"t;- x. w,.A�A^di.,'.. .:'r',.' ,} .[ _ " .:�. �l-S; IU�2 y =.t. .'��Ih:f.. '.'lij='r 1%'aSriTFyc:✓:�•fy':t iAq -1.1`rir t.:'-i2:'^;��_ '�''?:%'l:.r��;A. sr '..+,. - !� o-�1 SP;r•.. '•r../s' ' " "l>� .rk%j%'�:.r.. r.rr :TirP,-':�Jr,(Y. ,n'E .r•G.t • : - { .^ rvx• .J)� ";?/Xae K hY C*��f( t �K'S 1 x er NX if r��' y ^�.t �}��'.�y' �,{ 4p j�'f��!y��q (y �Fa7 Q(~aVlu. Zf I.11 -lar �%i✓PTT•�Y'Vr!rw- Q s}a!5tI`r t)1®r1SA`n YT.rt� J : r .. L�F.:�.J�r i. .r.. f},5 u.dFtn� i$ .2 ri..f EReceived Time Oct. 29. 2012` 9. 17ArNo. 1508= 914112