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b4/19/2013 21 :44 FAY <br /> :.DATE RECEIVED EHD LOG NUM13ER <br /> SAN JOAQUIN COUNTY <br /> 1,F111.LE, U, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E"t Weber Avenue, 3"Floor, Stockton, CA 95202-270/9 A <br /> t 2007 Telephone.(2Q9)468-3420 Fax:(209)464-0138 Web:rwww.sjgov.org/&0. <br /> A <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: - I--' BUSINIESSIAGENCY.-, <br /> ADDRESS: 3 Pt 2g 5�: kYl MC I'M I=; I AfLt;g, . 504C[ AA'2142 U; <br /> PHONE(t): "It PHONE(2): -?`i 03 —FACSIMILE: ?�l 1,o �tSQ obr)'3 <br /> TENTATIVE*APPOINTMENT DATE: 51217 <br /> Time: to6t> <br /> (Phmae allow 10 business days from dad of application submittal-'Tentat.fvO Only-Must be confirnwo) <br /> 13 CHECK BOX TO EXPEDITE <br /> rE REQUEST-$95-00 FEE(CASH OR CHECK ONLY)-REOVEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S I10:7 <br /> [Electronic Information: 0 List El Map Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street i $treat Name city Q Unit I <br /> 0 unit 2 <br /> 2. <br /> 3. AJ <br /> unit 3 <br /> 4. <br /> 5. <br /> ------- AV,- <br /> 11,17 C <br /> 7. ❑ <br /> Unit 5 <br /> 8. <br /> 9. *irunit 6 <br /> 10. <br /> Elio.. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> sdUNDaRuRouNo TANK(UST)CLEANUP SIVE(LOP) 11 HcKmNo ABATEMENT 14SOS WASTE FACII.rryivemcm <br /> 19 OTHER CLEANUP SITE(NON-LOP) 171 FOOD FAcii-rry 13 WASTE TIRE <br /> 9 UNIDERGROuND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 10 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCK [I WASTEWATER TRMTMIENT PLANT <br /> J4 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER Tm=KNARDICHEm TOILETS <br /> C3 TATTQQMOUY PIERCING M POOLISPA 171 LAND USE APPLK;ATioN SITES <br /> 0 MEDICAL WASTE FACILITY 6 OTHER(PLEASE SPECIFY] <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 0:00 AM-6--00lam - ExCLUOING HOLIDAYS. <br /> 7. List up to ten addresses In the space above. select the type(s)of filoo from the net above by checking the appropriate <br /> box(as). At least one file type MUST be selected. Fax to(209 464-0133 or all to the address Indicated above. Address - <br /> ranges will not be accepted–for additional assistance with file addresses,contact the END.Applications received after <br /> 3:00 pill will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist An&ppolntmgnt for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for 8 maximum of five business days.for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A Vie that Is actjvvty being worked an by EHD staff may not be immediately available for review. .A new application may be <br /> submlftd 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$95.00 deposit prior to review. <br /> EHD U5F-ONLY <br /> RHD ;Q <br />