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11/19/2012 14:45 916648664 ADR . PAGE 02/02 <br /> EHD LOG NUMBER �±1 <br /> REZ ED $ANTAL H COUNTY <br /> 1� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-62.32_ <br /> NOV 19 2012 <br /> Tolephone: (209)468-2420 Fax: (209)464-0138 Web:wwW.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> ` ` eU31NES51AGeNCY: •(�E� t<7J1✓ I�ap� 1 1 <br /> APPLICANT; ��A3AJ1S •�(sinS, i�9 _ <br /> CITYISTATEIZIP:SA <br /> ADDRESS: 2-1SAc)T►� rte- _ _ iAmfzl aIS 16 <br /> PHONR(1): 13 -4'25PHONFr (2}: 16—ydq— S6Q ' FACSIMILH:.71)r '(+ ��^4G6t3 <br /> TENTATIVEWPOINTMENT DATE: i\I'2"7 Zto 1'2- Time; <br /> (PFe35oallow10 bumnesa days from da ofapplioollonaubmlual- TenfeflVo only-must ha con -mad) <br /> �CHFCKeOXTOEXPEDITERE VEST-6125F (CASH OR CHECK ONLY)-REQUEST PROCE55EDIN3 USIN SDAY9 <br /> SIGNATURE OF APPLICANT -l�Ga.� DATE it <br /> `� Zl�1 2 <br /> Elecfronlc Information- ©L1st Q Map-Descriptlon:-_ <br /> FILE ADDRESS END USE ONLY <br /> Street Street Name city <br /> 1. 1i4 WL]UnA2 <br /> 2. 12 <br /> 3. I.W ❑unity ll <br /> 4. <br /> 5. <br /> 8• ❑Unit 4 <br /> 7. <br /> ❑Unit S <br /> B. <br /> 9. <br /> 10 ❑UnIt Z <br /> SpaolNoDAla Range of Information Requeetad: From t to DR fSChiT <br /> ENVIRONMENTAL HEALTH EPARTNIENIT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]HOUSING ADATEAIENT �SotEO WASTE FAc1L1TYAfEHICtE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTETIRE <br /> ❑DAIRY <br /> UNDERGROUND TANK(MONITORINGIR£MOVAL) ❑DOG KENNEL <br /> HAZARDOUSWASTG O ENERATOR []CHICKEN RANCH ❑WASTEwATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIMOTEL []PUMPER TRUCKIYAROICHEMIOALTOILETS <br /> ITATTOWRODY PIERCING ❑POOLISPA []LAND USE APPLIC0.T ION SITES <br /> 10 MEDICALWAGIE FACILITY COMPLAINT RECORDS ❑OTHER(PLEASES(`ECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVATI-ADLE FOR REVIEW; MONDAY-FRIDAY 6:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1, Llst un foten addresses in the space above. Select the type($)of files from the list above by checking the appropriate <br /> hox(es). At least one file type MUST be selected. FaK to f20914o4.Of S or ma11 to the address indtcatsd above, Address <br /> rangeawlll not be accepted-for additional assisfancewlth file address¢s,contaetthe EHD, Applications received after <br /> 3;00 pm will be process®d the next husin¢ss day, <br /> 2, The EHR will nOtlfy the applicant if any EHD files axtat. An appolntmeht for revl¢w will be confirmed approximately <br /> (10) <br /> days after racelpt of appllcatlon. The flies will beheld for a maximum of flue business days for roview. Appointments <br /> should be scheduled accordingty- <br /> 3. A fife that is actively being worked on by 2HR sFaEfmay not be Immedlalely available for review, A <br /> new application may be <br /> submltt¢d vthen the EITa Is available. Ilcant. <br /> 4, Any file not returned In the same CondIVOn as released will be reorganized by RHD staff at the expense of the app <br /> Future file reviews by the same applicant may require a$125 depcelt prior to review, <br /> 99 EHD n9a avLY <br /> 1111 <br /> UD 4845 <br /> Received Time Nov, 19. 2012 2; 31RI No. 1664 <br />