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DAVrnr [[.f�[U IJ z: z rm <br /> SAN JOAQUIN COUNTY <br /> IRONMENTAL HEALTH DEPAR" ANT ^1 <br /> I ■ 18667�ast Hazelton Avenue, Stockton, CA 95275-6232 �! <br /> ■ MAR 2 2 2013Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> `N�nt3N�_��r�t Ha' stt PUBLIC RECORDS RELEASE APPLICATION r <br /> APPLICANT: An rew1� f ae� BUSINESSIAGENCY: <br /> ADDRESS: l s`33 [7 15t r�eA CITYISTATE/ZIP; <br /> PHONE (1): 9_10-A'17-188f" PHONE(2): FACSIMILE: fd-88CO- S`351 <br /> TENTATIVE-APPOINTMENT DATE: — 13 _ Time: <br /> (Please allow 10 business days from date of application submittal-•Tentattve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$12 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSrfINESS DAYS <br /> 'SIX <br /> OF APPLICANT DATE 0i'^p;Z'13 <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City ❑LI1 <br /> AT <br /> 2. .r_ od'e%t ` i Ldrm NUtZ!�7G' Unh2 <br /> 3. 0 U v ova k�f, h , w , <br /> 4. _Z Unit 3 <br /> 5. <br /> 6. _ ❑-U'nIt4 <br /> 7. Ild lid WIV Yen" La <br /> 8. A 11 C2 Unit 6 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> AT L7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE - <br /> E <br /> HER CLEANUP SITE(NON-LOP) E7 HOUSING ABATEMMENT ❑WASTE TIRE i I f71 PS �lDERGROUNDTANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY lam° olV3OVEGROUNDTANKy, ❑CHICKEN RANCH/DOG KENNEL WASTEWATERIREATMENTPLLANT <br /> RDOUS WASTE/HAZARDOUS MATERIALW ❑MOTELIHOTEL UPUMPERTRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY X. ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 'LjTATTOO/BODYPIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLFASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8;00 AM-5:00PM(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)464-0136 or mall 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 hot be immediately available for review. A new application may be <br /> submitted when the 01e 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 alicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> a - <br /> ".. C ate` <br /> >,. <br /> Vop <br /> WNWA m .xa <br /> n n �ecv ,tii...Fn. mny'. Pt C1, <br /> Received �'/. r 22. X2013 2: 24P No. 2620 <br /> LHV 4e-Ub W4112 <br />