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tinju Y to EHD LOG NUMBER <br /> DATER6)CEIED <br /> 3 2012 10 SAN JOAQUIN COUNTY <br /> lAA ENVIRONMENTAL HEALTH DEPARTMENT <br /> \ V <br /> ENVIRONMENTALHEAL10 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVIGfigephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: V1Gaa I�CGtg;5;AJ BUSINESS/AGENCY: FNKorj <br /> ADDRESS: 22SS wlU 5Ki6'—E �! iD CITY/STATEIZIP: �S HNbG—/�5 } 90c�ica <br /> PHONE(i): Z671 0—�SSS PHONE(2): FACSIMILE: 2l3-7 o—pSpS <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUE - 12 FEE EC Y)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 'L <br /> Electronic Information: 1] List❑ — s hPfion: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 1 <br /> I <br /> oe <br /> 2. ❑Unit 2 <br /> N 3. <br /> f r <br /> 4 .LSI Unit 3 <br /> 5. <br /> 6. "it 4 1 <br /> 7. <br /> 5 Q Unit S <br /> 10. ❑unit 6 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILfLPt'NEHHICL I <br /> fjje�HER CLEANUP SITE(NON-LOP) Ll FOOD FACILITY ❑WASTE TIRE v / I e ' "" <br /> 6ERROROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY �/� 7-4- ( —L' <br /> DOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATERT EATMENT NT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1, List Uo 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)464-01385d mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Appllcaaons 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 /> 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> 1 n 7l <br /> •) l <br /> l � ) 131 <br /> Received Time Jul. 2. 2012 4:22PM Na 0442 oraeno <br />