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Q4/18/2013 21 :44 FAX Z001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT nn c <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-270> I S <br /> y, L Iu7 Telephone: (209)468.3420 Fax: (209)464-0138 We www.sjgov.org d t <br /> - ' PUBLIC RECORDS RELEASE APPLICATION <br /> r, <br /> APPLICANT: BUSINESSIAGENCY: G'n j:rr S2 r%f (o <br /> ADDRESS:s4 22 <br /> PHONE(1): *11 07 CI-7 PHONE(2): -Ili(e `1 22� 1113 FACSIMILE:_ Ito k$O o In r)3 <br /> TENTATIVE'APPOINTMENT DATE: 5�2sf0 7 Time: (L O—> <br /> (Pleura allow 10 business days from I p 6 tion submittal-•Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$05 00 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ' vl r _ _) 771)"10 DATE j/1110:7 <br /> Electronic Information: ❑ List❑Map—Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street�' Street Name City \ Q unit 1 <br /> LAL <br /> bW 2• UST (oID) --j--i Lluaa2 <br /> 3. I 1 '7Y' <br /> Unit S <br /> 4. 1131 1 o Dr- t.tsT OLD) <br /> I 5. C rAt'"I Avt. Unit \J <br /> I f u/ r ❑ Unit a j 1 <br /> 8 O <br /> 9. Unit6 <br /> 10, <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Id UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLED WASTE FACILnyivrm CLE <br /> 19 OTHER CLEANUP SITE(NON-LOP) M Foon FAcu.rrY O WASTe nRE <br /> Of UNDERGROUND TANK(MONITORINDIREMOVAL) 13 DOG KENNEL 17 DAIRY <br /> yHA DOUS WASTE GENERATOR C!CHICKEN RANCH E l WASTEWATER TREATMENT PLANT <br /> JA TIERED PERMTrED FACILITY 0 MOTELMOTEL O PUMPER TaucKIYARDICNEN TOILETS <br /> 13 TATTOOfBODY PIERCING ❑POOLISPA 0 LAND Use APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 6:00 Atb6: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(2091464-01133 or all to the address Indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addressee,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) 01 <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 EHO 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 reorganised by EHD staff at the expense of the applicant- <br /> Future <br /> pplicantFuture file reviews by the same applicant may require a$96.00 deposit prior to review. <br /> EHD USE ONLY <br /> eso•wr Iaame <br />