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I.r JAN.25.2013 1:50PM RAMCOENG & ENV CTG <br /> r'■ N0.807 P.lil <br /> I DATE RECEIVED EHD LOG NUMBER <br /> ION �6 � SAN JOAQUIN COUNTY <br /> •6 ENVIRONMENTAL HEALTH DEPARTMENT /�1^1/�� <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 " \1 1 J <br /> OAN 2 5 74Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd OW <br /> vispa: ' 1 <br /> r., 110NNi�N?� nrES PUBLIC RECORDS RELEASE APPLICATION <br /> I G�FT� <br /> APPLICANT: (( QM o „ Fra �L�er:nG BUSINESS/AGENCY: <br /> ADDRESS: I1t'5'O f (prbor l?(dd. Su;�e CITY/STATE/ZIP: (vett Cies¢ ze �D (A.SS�Y/ <br /> PHONE(1): 9Y(o -372 7S 3S" PHONE(2):Jlji 5;V7 157YY FACSIMILE: 9/G 71 y tp9 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submitral-'Tontadve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS SAYS <br /> SIGNATURE OF APPLICANT ��z 7el(,o 1' 0ike^S DATE //a5-//3 <br /> Electronic Information: ❑ List❑ Map—Description. PH S—EN 1-66 # 63-673 <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 7. .2.3577 <br /> 2' ;n a� Pank✓. titre (14 ❑Unit2 <br /> 3. 71 ' <br /> 4. <br /> 5 A Unit 3 <br /> 8. <br /> g El Unit 5 <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of information Requested: From 1.2 J// Z Op to 6 /�/ zO -2 <br /> ENVIRONMENTAL H L DEPARTMENT FILES 1 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY ❑SOLID WASTE FACIU Y/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINB/REMOVAL) E]FOOD FACILITY ❑DAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL <br /> HAZARDOUS WASTEMAm mous MATERIALS MOTE/HOTEL ❑WASTER TRUCr YARD/CHEMIC L <br /> TIERED PERMITTED FAcLay ❑ ❑LAND RTRUCKICARON SITES AI.TOILETS <br /> ❑POOUSPA ❑LAND USEAPPUCA710N SITES <br /> ❑TATr00/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA5LE FOR REVIEW: MONDAY•FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(&)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail 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 may not he 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 expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. 11ENOXEtD ASM—M ND Lii 0NL1S <br /> Records provided by Staff,PPR Complete. Stag Name; <br /> eMoaaoa <br /> Received Time Jan. 25, 2013 1 :44PM No. 2170 'Iu" <br />