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V DAMar 22 2013 2: 23 PM SAN .IOAQUIN COUNTY No. 0330 Ef P. 1GNUMBER <br /> i - <br /> ANVIRONMENTAL <br /> HEALTH DEPARTMENT 1 <br /> 'ism 1868 East Hazelton Avenue, Stockton, CA 95205-6232 YI� <br /> iviAR ', 6 20i'Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: WwW.sjgov.org/ehd <br /> ,•;;r " '`• '' 1`: PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; n re(,� r app BUSINESS/AGENCY: S tttpoykth <br /> ADDRESS: LS`33 B �SYr�e� CITYISTATE/ZIP: i4a Iq({ rcirf <br /> PHONE (1); 9`10-AK7~ 9895' PHONE(2): FACSIMILE: fa-88G_ S`39°1 <br /> TENTAT/VE`APPOINTMENTDATE: 9-- - t-S Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> XARE <br /> ECK BOX TO EXPEDITE REQUEST-$12 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313USINESS DAYS <br /> SI OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY A <br /> Street# Street Name City ❑ Unit 1 <br /> 1- s cam,► ~~ s �� ��. <br /> 2. S' a-r A e-I R S 0nit 2 <br /> 3. t7f> rr on v,52�� J <br /> 4. 17 UU <br /> ® iniE 3 <br /> id, Tj wlY 11 Li El Unit 4 <br /> 7. 4WO V <br /> 8. <br /> Unit 6 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NiNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY —1 SOLID WASTE FACILITYNENICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> DOWGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL 18WASTEWATrR TREATMENT PLANT <br /> AZARDOUSWASTEIHAZARDOUSMATERIALS ❑MOTEL/HOTFL. U PUMPERTRUCK[YARDICHEMICALTO]LETS <br /> *JXTIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un 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 f209)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/nay 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 atthe ex ease of the glicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> V a iy. r4� '�•-r ✓ try: yc. 7T -tr �.`f .. <br /> g' ins+. ,:aev.l'W t <br /> rrt;y <br /> t 1pnny is s r -� r i:.. •':.0" ^e3p? sr�g`"rif': <br /> Y �41�•,4lldae:2 �`1,k`B .f.� Ir., /i N ..,F,.�� <br /> m <br /> eceived 13 :541( N'o' <br /> i< 2620 <br /> RTime' Mar, 22. 202: 24PRI , <br /> tHU 4V-VY 914112 <br />