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JRN.25.2013 1:5OPM RAMCON ENG & ENV CTG <br /> I N0.807 P.lil <br /> I DATE RECEIVED EHD LOG NUMBER <br /> SAN .IOAQUIN COUNTY '� w <br /> ENVIRONMENTAL HEALTH DEPARTMENT /� <br /> 868 East Hazelton Avenue, Stockton, CA 95205-6232 ' 1X131 1 <br /> AN 2 5 lViTelophone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd dyJ <br /> �.,.I Iclrlrn�NT'�; � sLi� PUBLIC RECORDS RELEASE APPLICATION <br /> PF:R�au ' <br /> APPLICANT: ►C Q ryl �� �na t t�ep ti BUSINESS/AGENCY: <br /> ADDRESS: If(SO h'n/ bor CITY/STATEOP; <br /> PHONE(1): PHONE(2):_ Li; 227 67y9' FACSIMILE:_9/G 7.2 5 .209 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of appllratlon submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS9AYS <br /> SIGNATURE OF APPLICANT ��'�!/j o ?e dt!o SF<a ke^S DATE_ (/� <br /> Electronic Information: ❑ List❑ Map-Description: PH S-9'b4 Ld1, # d3"n-'3 <br /> FILE ADDRESS EHD USE ONLY <br /> �J� StraetC Street Name City <br /> 1. � ' � ,,.E a r• c ,¢. � _ +t c w�O Unit! <br /> Z o <br /> %n u Pc�kw. Mne04 VI/ <br /> 3 <br /> 4. <br /> 6. j <br /> 6. 77:_I-- <br /> 8. <br /> e ❑Unit 5 <br /> 16. <br /> ❑Unit 6 <br /> Specific Date Rango of Information Requested: From / 2 GO to 20/� <br /> ENVIRONMENTAL IH&L DEPARTMENT FILES ! <br /> #UNDERGROUND <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOUD WASTE FACILRYIVQII <br /> OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT ❑WASTETIREIh�p_ Jy) (A.I)�TANK(MONITORING/REMOvAL) ❑FOOD FACILRY ❑OARy �Y2�" <br /> P'llpOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMExT PLANT J <br /> HAZARDOUS WASTEIHAZARDOUs MATERIALS ❑MOTELMOTEL ❑PUMPER TRUCK(YARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOVSPA ❑LAND USE APPLICATION SITES <br /> ❑TATIOO/BOGY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑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 up to ten addresses in the space above. Select the types)of riles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. ,Fax to(209)46"138 or mail to the address Indicated above Address <br /> ranges will not be accepted-for additional assistanea 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 n <br /> applicAt <br /> expense of the the a <br /> Future file reviews by the same applicant may require a$125 deposit prior to review, r"BOxCD AREA Uel? l t <br /> 3 �. .. <br /> ecords provided by Staff PPR Complete.stapmama, <br /> Received Time Jan. 25• 2013 1 :44PM No, 2170 91""' <br />