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ROM ERAS 60Vr------Sal. 1— (PR]>JUL 27 2012 11:00/ST. 11:38/No 75000000AH P l <br /> RWEIVE® ,� SAN .IOAQUIN COUNTY EHD LOG NUMBER <br /> F( n <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUL 27 2012 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATIONCIA <br /> I <br /> APPLICANT: v, BUSINESS/AGENCY: - V <br /> ADDRESS: 3 CITYISTATE/ZIP: 111 <br /> PHONE(1): _ 10 2'� Y_ p� PHONE(2 : FACSIMI E <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business from t'0 pplidation submittal-*Tentative only-must be confirmed) <br /> F]CHECK BOX TO EXPEDITE RE UE -$125 E( SH HECK ONLY)-REQUEST PROCESSED IN BUSIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE L Z <br /> Electronic Information: ❑List❑ Map—Description: <br /> 1, FILE ADDRESS EHD USE ONLY <br /> D ILt.� StreetO Street Name City Eltinitl <br /> 1 S S E �n , <br /> 2. - GJ� jjunIt2 <br /> 3. Q TO11 S)GDIS <br /> 4. nit 3 <br /> 5. <br /> 6. vita <br /> 7. <br /> a• ❑Unit s <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From - to <br /> _ ENVIRONMENTAL H ALT DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICL j <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE IO�fi- h/� <br /> NDERGROUND TANK(MONRORINGIREMOVAL)� ❑DOG KENNEL El DAIRY gHR F1 [71 <br /> A2ARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT LANT <br /> IERED PERMrrTED FACILITY T$- ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATToOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICALWASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM5:OOPM(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 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 he <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 /> -. _Us` I'M <br /> COAfin I5 <br /> q , s- <br /> I <br /> EHD"4 all/11 <br /> Received Time Jul. 27, 2012 11 :48AM No- 0661 <br />