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02/10/2012 14 :50 FAX • a001/001 <br /> • <br /> DATE RECEIVED EHD LUG NUMB <br /> tt SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT I <br /> : $ 600 East Main St. Stockton, CA 95202-3029 <br /> ./)Telephone: (209)468-3420 Fax: (209)464-0138 Web: wwws)gov.oTg/oh <br /> ZAt NFr�1 `Tb <br /> urtNFRv1cFs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: V�� JA2fJS BUSINESS/AGENCY: FA99(41S>:12gmizS 14c <br /> ADDRESS: �L{�� h .(fi�l t5Yt1�JG CITYISTATEIZIP: A'wvp f- c4 <br /> PHONE(1): 6 8y -23I S PHONE(2):_9/( yep--023`f FACSIMILE: (y(6)t/Ai 0(10'3 <br /> TEN AT/VE'APPOINTMENTDATE: Time: <br /> MOM allow 10 businass days from dale oI epPllcation submittal-'Tentsom only-must be Confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUES FEE HO HECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2//D/ZoI '2_ <br /> Electronic Information: ❑List❑ Map•-Description: <br /> FILE ADDRESS -City EHD USE ONLY ' <br /> SheetA Street Name <br /> n <br /> (� 2' I TQ� t"IJQ.QNI 1'F��-T�✓•'PG t-A'rF� AJ AI Unit <br /> U 34 0 v A Pniz TWV-1 r o <br /> 4. 1170 Spv114 N p L A IWf_o (AI yl <br /> nna <br /> 5. I q1P 0 N ONOrt5P <br /> B. <br /> 2401114 <br /> 7. <br /> e. <br /> Unit S <br /> 9. <br /> 10. <br /> uDn s <br /> SpaciFio Data Ranga of IMormation Roquastod: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE f t' <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIREI 1 3. <br /> UNDERGROUND TANK(MONITORINOIREMOVAL)Q' ❑DOG KENNEL ❑DAIRY <br /> KA HAZARDOUS WASTE GENERATOR dl ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C�_ ❑MwELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOo/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FAcaTIY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 8:00 AM3:00PM(EXCLUDING HOLIDAYS) <br /> 1. List ug 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 12091464-0138 or mall to the address indicated above. Address <br /> ranges will not he 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 tan(10) <br /> I 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 /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> Z; tD CO 3 8ED I X05 <br /> IO (8 <br /> V <br /> d <br /> EHD 48-06 Will <br />