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"mi c l v t u EHD LOG NUMBER <br /> "'7')5Z7' <br /> ATE REC IVSD <br /> )�� 3 2012 "' SAN .IOAQUIN COUNTY — ksq ENVIRONMENTAL HEALTH DEPARTMENT ENVIRONMENTAL HEALTH600 East Main St. Stockton, CA 95202-3029V <br /> PERMIT/SERVl*§ephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ?_1yc7 BUSINESS/AGENCY: r/�JC,tD/� SrJL✓Tlo�lt <br /> ADDRESS: 32SS (tiIGS!-r/G'-� �/-�, �ISVe CITY/STATE/ZIP: Z.S f-t../6E/ SC¢i- 9t7orco <br /> PHONE (1): PHONE (2): FACSIMILE: T/3—YiO-05o3- <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 2 <br /> Electronic Information: ❑ List❑ — scription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City 1 <br /> 2. ❑Unit <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> J <br /> 6. ,Q umlt a <br /> 7. <br /> a. O Una s <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> EjAJS_DEjiGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT �,I SOLID WASTE FACIL NEHICL <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE hI.-P Sir <br /> Ck�WEPGRoLND TANK(MONITORINGIREMOVAL) ❑DOG KENNFL ❑DAIRY 7_Pa <br /> / <br /> RDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMIcAL TOILETS <br /> ❑TATTO0I9ODY 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 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addre$s_e_s 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 mail 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 /> 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 /> CHO e6E ONLY <br /> I e 1 �( <br /> n ' ti2 <br /> Received Time Jul. 2. 2012 4:22PM No. 0442 071 <br />