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02/10/2012 14:50 FAX 007/001 <br /> DATE RESAN JOAQUIN COUNTY RECEIVED EHD LOG NUMB <br /> �eGS,v ENVIRONMENTAL HEALTH DEPARTMENT4 <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> O jZlylephone! (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> �NSAytc s� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 7 �S BUSINESSIAGENCY; &4eZCD/J, 502- (GES 144 <br /> ADDRESS: "rt{14 Pq4a�( E CITY/STATEIZIP: SA $ T-a r CA 9S7d2 <br /> PHONE(1): 6 Sy —281 S PHONE(2): q/(� &D-O?=3`� FACSIMILE: 16XJh 0603 <br /> TEN ATIVE'APPOINTMENTDATE: Time: <br /> (Plaaw allow 10 business days from date of application submittal-'TenNWa only-most be confirmed) <br /> ❑CHECK BOX TO EXPEDITE RECUES FEE H 0 ECK ONLY)-REQUEST PROCESSED IN 3.BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2/lo/Zol 2 <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Streat Name Clry <br /> 6 - � S r7 t3 <br /> t n <br /> 1. <br /> z. unlZ <br /> 3. w/s <br /> 4• 4 LA-TNeo nN s <br /> 5. TO NO <br /> S <br /> � <br /> 7. <br /> a. <br /> Unit a <br /> 9. <br /> 10. j 9 <br /> unit s <br /> Specific Date Rango of Information Raquastod: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �" rV 41 <br /> r� <br /> la UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]HOUSING ABATEMENT E]SOLO)WASTE FACILITYNEHICLE _; T}I (43J <br /> _ <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY El WASTE TIRE LW- 13� 1 <br /> UNDERGROUND TANK(MOMTORINGIREMOVAL) DOG KENNEL ❑DAIRY 'd,2C� 1;L <br /> HAZARDOUS WASTE GENERATOR til ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C�_ ❑MOTEL/HOTLL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOBODY PIERCING ❑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:OOPM EXCLUDING HOLIDAY$) <br /> A. List up,to ton addresses in the apace above. Select the types)of files from the list above by checking the appropriate <br /> ! box(es). At least one file type MUST be selected. Fax to 12091404-0138 or mall to the address indicatedghM. 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 appolntmentfor review will be confirmed approximately ten(10) <br /> I days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> i 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 /> 14. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future <br /> —file reviews by me same applicant may require a$125 deposit prior to review. <br /> aj �' !i• W W 3 5E0 <br /> OD aA <br /> a <br /> EHD 4"t enHt <br />