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Aug. 13. 2013 4: 28PM fro, 0021 P. 2_ <br /> EF���...�NUMBER <br /> RE"tal V <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT a <br /> AUG 13 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orglehd <br /> ENVIRONMENTAL 1-IEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION nn <br /> APPLICANT: �jQ,rGt. 51� <br /> BUSINESSIAGENCY: }-eA- U Y r ti <br /> ADDRESS: IteS N ° IYSf �l�lL{ �� •?-D) CITYISTATE/ZIP: �Q-� �a�. (pr RS11� <br /> PHONE(1): (�� G1�� r PHONE (2): (i2LP 2yg- Q�18 FACSIMILE <br /> 7'E AT/VE°APPOINTMENT DATE: U-e5 totV mS-t• Z7 ' Time: p.t�►+ <br /> (Please allow 10 business days from date of appllc Con submittal -'7enfative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE ST-$126 (C SH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 8131 l3 <br /> Electronic Information: List ap—Description: Midwn Ori 04 %Z .iI 4 feak Is I aKd S <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2- unitz . <br /> 3. if, <br /> 4, fE' SiYc C I �DG��►� (� •�J Unit05 a " <br /> 7 KC11,1111Wata! C- <br /> Unit 4 <br /> D <br /> 7. <br /> C UnitIs <br /> 0-Unit 6 <br /> t <br /> - - Q. s o n <br /> Specific Date Range of Information Requested:---From` Q <br /> ---- ENVIRONMENTAL HEALTH DPARTME T FILES <br /> [61NDERGROUND TANK(UST)CLEANUP SITE(LOP) QMEDICAL WASTE FACILITY OLID WASTE FACILITYNEHIGLE <br /> OTHER CLEANUP SITE(NON-LOP) ElHOUSING ABATEMENT 0WASTETIRE <br /> � IRY TREATMENT PLANT <br /> �1NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DA <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL E WASTEWATER <br /> R HAZARDOUSWASTENAZARDOUSMATERIALS ❑MOTELIHOTELL✓1rUMPERTRUCKIYARDICHEMICALTOILETS <br /> E�IIIERED PERMITTED FACILITY ElPOOLISPA 'LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LL FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up 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 209 464-0138 or rnall 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 rnay not:bo Immediately available for review. Anew 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 flle reviews by the same applicant may requlre a$125 deposit prior to review. � BoCE E H SIS 4, <br /> / t <br /> e <br /> R ❑ Records.hrovided by Staff'-f'PR C'omplC:ie. Staff Name'. <br /> 9141:12 <br />