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11/1942012 14:45 916648660 ADR PAGE 01/02 <br /> S �OL <br /> OATF Rt OEIVED I — HD 00 NUDER <br /> RECEIVES sANJoAOu,NcouNTY Pm ;d, ,�Cab tc <br /> ENVIRONMENTAL HEALTH DEPARTMENT FG j� �-Sf) <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ivy. I�i i- j�j�I j ep F (c, <br /> NOV 19 2012 Telephone: (209)466-3420 Fax: (209)464-0138 Web:vvvvw.ajgov.org/ehof <br /> . <br /> ENVIRONMENTAL HEALTH rva <br /> 0 <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: h1►S1S �+t,10�Qf� BUSINESS/AGENCY:.. �Vyl(Q rt �ilt�}^jY�L <br /> ADDRESS: Z Z'w7 '3p ST -'Z02- CITY/STATE/ZIP: S f(� Q �J �1I <br /> PHONE(1)i q16 —' � -�iLb`1 PHO ): 16-yb -U FACSIMILE: I b —t� <br /> TENTATIVE"APPOINTMENT DATE: IN-717e 1.0~- Time: <br /> (Please allow 10 business days from clam of application submittal.'Tentative only-must ba conflrmed) <br /> CHECK BOX TO EXPEDITERE UEST-$125 (CASH OR CHECK ONLY)•REQUEST PROCESSED W 2 VUSINE S DAY$ <br /> SIG ATURE OF APPLICANT Ti[ _ prj,c,k DATE Il/ 19 2 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Sleet q Street Name City Q Unit 1 I <br /> W i ❑Unit 2 <br /> 3. Zy IJP I9YSlC <br /> 4• ,� <br /> 14f-C- t L� 3rau ��rn fi]unit3 y <br /> 5. 1'2j al '2 &S <br /> 6. f>: 2-96o I:S pC�e.2Sltc� 1 ✓1 f-Zt� ff6nh4 <br /> 7, L5Z 1Hie— C5f-e-m(ixk <br /> B. ')-S 4 1 L ,3l ❑units <br /> SpcoiIla Dale Ran go of ihformallon Rcqucsted: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) []HOUSING ADATEM.ENT 1K SOLID WASTE FACILITY/VENICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTETIRE <br /> UNDERGROUND TANK(MONITORINOIREMOVAL) ❑DOOKENNEL DAIRY <br /> HAZARDOUSWASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUTAPERTRUC}(IYARDICNEM)CALTOILETS <br /> ❑TATToofBoDY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> Ea MEDICAL WASTE FAOILffY W COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY') <br /> WELLAND SEPTIC PERMIT REcoRos ARE AVAILABLE FOR REVIEW: MDNDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uD to ten addresses In the space above. Select the fype(s)of flies from the IIsi above by checking the appropriate <br /> box(es). At least one Elle type MUST ba selectod. Fax" (2(191484-9190 or mall to the address Indicted above Address <br /> ranges will not be accepted-for additional assistance with Ole addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day, <br /> 2. The EHD Will notifythe applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flea will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that 1s actively being worked on by EHD staff may not be Immediately available for review. A navy appilcatron may he <br /> submitted when the file Is available. I <br /> 4, Any Ole not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future fila reviews by the same applicant may require a$125 deposit prior to review, <br /> E ada.Ga tYI t <br /> Received Time Nov, 19, 2012 2:31PM No, 1664 I <br />