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,9_AJJ�_--itU)_-IVtu <br /> SAN JOAQUIN COUNTY <br /> RECRVED EN' `,ONMENTAL HEALTH DEPARTM T <br /> 1868 E,st Hazelton Avenue, Stockton, CA 95205-L:232 <br /> NOV 112 Zoffelephone; (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH' <br /> PERMiTIaERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /C/`� BUSINESSIAGENCY: �� /JJ ; T <br /> T <br /> ADDRESS; �Q G� !SU1y )1!5CITYISTATE/ZIP: � �r�/yJ� _ /<l U ✓' � <br /> PHONE (1): ^�/� S� . ADO PHONE (2):��� 2 �f FACSIMILE: flo" <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 REQUEST-Sl 25 FEEKCASH O ECK ONLY)-REQUEST PROCESSED IN 3 BU INES DAYS <br /> SIGNATURE OF APPLICANT1V12 <br /> Electronic <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# _ Street Name I City ❑ Unit 1 <br /> _ I 0 ��vTff_//�igr✓ FC.�9 74r �'► +��r iJ� rte_. -- <br /> IU� 2. [] Unit 2 <br /> _. <br /> 4. I ---- _.,— ---� - -[3-6nit 3 � <br /> .5._ f <br /> � <br /> � _ - <br /> 6 I _ 0'Unit 4 <br /> 7-I ....__ -.. Unit 5 <br /> 8. <br /> 9 _ <br /> 10. 'Jnit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT E]SOLID WASTE FACILITYNEFhICLE <br /> THEIR CLEANUP SITE(NON-LOP) ❑ <br /> FOOD FACILITY ❑WASTE TIRF ./1 I I P (7 <br /> I— AZARDOUS <br /> NDERGROUND TANK(MONITORINGIREMOVAL� ❑DOG KENNEL ❑DAIRY -ic6bli t-(- )I4i-1 Z <br /> WASTE GENERATORS L]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TATTOOIUODY PIERCING ❑POOUSPA ❑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-5:00PIVI (EXCLUDING HOLIDAYS) <br /> 1. List up 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)464-0138 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 confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business da ys 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 /> _. r_wo u_;r.;ONLY <br /> Received Time—Nov, 12. -2012— 4: 12PW-No. 1604 <br /> EHD 4MG <br />