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vilval4viz 1V:U1 VAA SOU 44L OU61 IIL1h11NFFL.UktK IyjUUc UUc <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehdj,0jgq <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: V.6n nd.&(^ <br /> ADDRESS: �jl2Gj hl Gafes I�VL CITY/STATEOP:_ Q�YLOI 1pc Q3VA <br /> PHONE(1)i 615R L{3(Q b-rap PHONE(2): '55ct Q(l.e (((oZ FACSIMILE: 55q 44Z5yj -i <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of appiicatl 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 APPLICANTVX �� DATE <br /> Electronic information, ❑ List❑ Map-Description: <br /> DL FILE ADDRESS EHD USE ONLY <br /> Street If Street Name city <br /> 1, ❑Unit, 1 <br /> B��S Ze0 i t r S-f f <br /> z. / ay �' / `' I <br /> n!o [ Co/54 <br /> { - Q NJ I.in I Unit <br /> 3. ( D 41�fCt�f'I»a_ �Is2{ E ND zJ Q <br /> IOP4_�L LO LA 7- it <br /> 5• 7 4,j �( I Un t 3 r <br /> lA 1 ��r l 5� IJq Lf1l`7 <br /> 6. _S: <br /> C }-/vTcc//1;' fa3lV� .fp Unit4 <br /> 7. ( C�r �`,/.(.� .t' icc„Li L7tliG N.J' .L�3(l/Y <br /> 8. <br /> e Ph f— af:,rr..' <br /> 0 c vnt¢ 3 uY�; units <br /> 9. <br /> � 10. <br /> ❑Unit B <br /> nn Specific Date Range of Infomration Requested: From to <br /> n11 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Li U DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> /a ❑SOLID WASTE FACI IVEHI�j,L,E //,, �-- F <br /> fn I-7.�OyTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY [:]WASTE TIRE I - . A,, llrrl ` 3" <br /> 2I��UNDERGROUND TANK(MONITORINGIREMOVAL)ol- ❑DOG KENNEL ❑DAIRY q <br /> S EKZARDOUS WASTE GENERATOR <br /> El CHICKEN RANCH j/❑WASTEWATER TREATMENT P PLANT <br /> o: JI L <br /> ❑❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL .� <br /> TATTOOIBODY PIERCING ❑PUMPER TRtiCi(/YARDICHEtACAL TOILETS <br /> rh ' ❑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-5:0DPM(EXCLUDING HOLIDAYS) <br /> H 1. List uo to fen addresses in the space above. Select the type(s)of files from the list shove b checking the appropriate <br /> p N box(es). At least one file Y 9above. <br /> A <br /> type MUST be selected. Fax to 120914640138 or mail to the address Indicated above Address � <br /> 4� ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after n <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 /> -a< 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 /> i <br /> 3. A file that Is actively being worked on by EHD staff ma no qe im���rrriilediately available for review. A new appilcation may be�' s, <br /> submitted when the file Is available. v (��i1 1 <br /> G — <br /> 4. Any file not returned in the same condition as rete ed wil b re rganized by EHD staff at the expense o' he applicant. <br /> Future file reviews by the same applicant may reire a$125 deposit prior to review. )� <br /> Z • HD USE <br /> -I o <br /> _Received Time—Jul. �2012-11 : 04AM_Na. 01297U-IZ� zOt�a73ps S X35 6 <br />