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III tAZ�jT��`J;y1a AC�.VIVIU �a -�.ys .,wr EHD LOG 14UM8 °E I V E D ! SAN JOAQUIN COUNTY 41 ENVIRONMENTAL HEALTH DEPARTMENT OCT 29 2012 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd ENVIRONMENTALHEALTH PERMITJSERVICES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: BUSINESS/AGENCY: y1�Oty� ADDRESS: I /tY-c:lVi>T Azr?-xo CITYISTATE/ZIP: CSR12-1L�La PHONE (1): (€'3/)7//7-oYb2. PHONE (2): FACSIMILE:1$65138 '-357? TENTATIV "APPOINTMENT DATE: Time: (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) ❑ CHECK BOX TO EXPEDITE REQUEST- 125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE yln410 oC'- 29,2o/Z Electronic Information: [-] List❑ Map— Description: FILE ADDRESS EHD USE ONLY Street# I Street Name city _ � dQ ❑Unit 11YFF e 0 nsa s ry h i, t-- WA 1 fflt 2. ❑Unit 2 3. 4. I _ Unita �7 5. 6. _ ,/❑Unit4 7. 8. ❑Unit 5 9.' 10. ❑unit s Specific Date Range of Information Requested: From ftn+LA ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIL(rYNER LE! ., OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT ❑WASTE TIRE �'�$ 7t/�W/1f�. UNDERGROUND TANK.(MONITORINGIREMOVAL)V` ❑FOOD FACILITY ❑DAIRY Y✓�jYl{� (�S-I Z m ABOVEGROUND TANK 0(_ ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT{SLANT HAZARDOUS WASTENAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKWARD/CHEMICAL TOILETS TIERED PERMITTED FACILITY 04, ❑POOLISPA ❑LAND USE APPLICATION SITES ❑TATTQOOODY PIERCING ®COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyIEw: 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 behold 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. i _ 7( b *' :A°>;os;,y.. t 3 3,< %+Y, a?:✓(i: :�;.y�":'r" 's?4+ ':r,': :;y.^.i•.;•.{t ydfrx-/.Ti n, fr r r�� rs; . F!:+1. 4: .GiS .;.ir r.%%•/r••? ;1rf.`'`�. /r ..Su+rf r f.:•r:.t. /- �?.xl tv: �+d..,,,s ,7FrAi vr.ic-,.4.r:o s._w.r,<i-.r.. ✓< i t (f l 4/LnF�JI^ ( !J R j:r Yfat: /•✓J't:.t'-il- '.r �0 l'..�.:.�;. ,li:i "ii /r 1 J r•,% ,Y,rk f1 r l /r(l�•s rl�f<„.^,i s}rr(s 1 t5 Js < 1 J '^ : iPd.Lvr i /I1 �Jw krJ t.�'( ✓� �..s✓t a 1 1 r.r 'xS .rr j� ,� '�y' s r �Y y', ,.pq`'�.}',L�p'p''/�� y, lvyh.:.(y 'UHrJ ,i�tr �C' x i xrrx rnlH.y .. < 1' 2GOT�'lS:; J:Olrtd. cl�fJ �'^�si�f�"moi/\'i.iV �C G .:�Y^ lT�ante,;;:r,}u'T•zlir«rt} �; .,(w::'. _R ived TIme-0ct. 29. 2012- 9: 17AWNo. Md 9f91�