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% k_ <br />)J� <br />DAMar.22. 2013 2:23PM SAN .IOAQUIN COUNTY No. 0330 EfP. 1GNUMBER <br />k ENVIRONMENTAL HEALTH DEPARTMENT 1 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />MAR d 2 2013Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �n rew apo BUSINESS/AGENCY: s Vt ti <br />ADDRESS: r33 B S�r'itj-- CITYISTATE/ZIP; <br />PHONE(1): �(0-�f{7 98�� PHONE(2): FACSIMILE: Ciro -886`S`331 <br />TENTATIVE'APPOINTMENT DATE: 9 - - 1 3 Time: C1.00 )kPL <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />XATURE <br />HECK BOX TO EXPEDITE REQUEST- SI ' E (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIOFAPPLICANT DATE R- <br />CHECK <br />Electronic Information: ❑ List ❑ Map- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # Street Name City <br />I/fCJ10UTt1 <br />P' No fX�l' u n g <br />2- <br />3. <br />0U ei aK <br />h`� T,' hy, Itgor. <br />l] Unita <br />4. <br />5. <br />041hit 4 <br />7. <br />L3 Unit 5 <br />8. <br />9. <br />❑ Unit 6 <br />10. <br />Speclflc nate Range of information Requested: From & L- Lr to <br />b. ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />X41IDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE _ <br />]��rrO�'THER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE i I (l I Pi k1 <br />2UNDERGROUND TANK (MONITORINGIREMOVAL) J� ❑ FOOD FACILITY El DAIRY P�i63 9-7-13 <br />BOVEGROUND TANK(7% 0 CHICKEN RANCH/ DOG KENNELWASTEWATER TREATmrNT PLANT <br />AZARDOUSWASTEIHAZARDOUSMATERIALS� ❑MOTEL/HOTEL 0PUMPERTRUCKIYARD/CHEMICALTOILETS <br />� <br />TIERED PERMITTED FACILITY,:X, ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />] TATTOOIBODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (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 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 />Any file not returned in the same condition as released will be reorganized by EHD staff <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />emu 4n -us <br />