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03/18/ 2013 09 : 08 53067661 - -�i STRATUS ENVIROMTAL PAGE 01 / 01 <br /> [7 <br /> I GI HATE REC . D7 A <br /> � . -- <br /> I _ f.- <br /> SAN J«JActUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTN ENT l <br /> Iv1A� 1 a 2013 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wl nv.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: /N4fioi' �/tt {fie!/ BUSINESSIAGEI, :Y: o541% 7 Cr:,fM � <br /> ADDRESS: 333DErart /� S7 e . SSD CITY/STATE! :IP: �rovr <br /> PHONE (1 ): S50 -313 - 4F9di( PHONE (2): - 2Y5'3- FACSIMILE: SSD ^ 6174 _ faDo�- <br /> TENTATIVE' APPOINTMENT DATE: 2d /qS 1 'S Time: L7 ! 00 K. <br /> (Please allow 10 husiness days from data of application submittal - •Tentatfve mly - must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEF r PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE y/ igl1� <br /> Electronic Information: 0 List 0 Mays a Description : <br /> _ FILE ADDRESS EHD USE ONLY <br /> Streat 0 Street Name city unlit 1 <br /> 1 . otf sof Gr`kh� �o`oC . I Z _ (✓'��+� — - <br /> . �t �/ n No � F4 vG v S2 �! cE � _. . ..❑ unR2 <br /> 2 <br /> 3. _..._ <br /> 4. un 43 J ' <br /> 6. _ <br /> Unit 4 <br /> 7. <br /> 8' — ❑ Unit S <br /> 91 <br /> 10. <br /> ❑ Unl¢ 4 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILTI IVEHICLE <br /> OTHER CLEANUP SITE (NDN•LOP) 0 FOOD FACILITY ❑ WASTETIRE <br /> ❑ UNDERGROUND TANK (MONRORNGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCKIYARDICHEMCAL TOILETS <br /> ❑ TATTOOtEODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8 00 AMS:OOPM (ExcLunrNO HOLIDAYS) <br /> 7. L s_t_0.A to ten-addresses in the space above. Select the typa(s) of files from the Hsi above by checking the appropriate <br /> box(es). At least one file type MUST be selectad. Fax to f2D91464.0136 or mall to t ie address Indicated abov . Address <br /> ranges will not be accepted at for additional assistance with file addresses, contact he EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> Z. The END will notify/ the applicant if any EHO flies exist An appointment for ravlaw All be confirmed approximately ten (10) <br /> days after racelpt of application. The files will be held for a maximum of five busln ss days for review, Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately avallab a for review. A new application may be <br /> submitted when the file is available. ' <br /> 4_ Any file not returned in the same condtUon ou released will be reorganized by EHD ItaM' at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $125 deposit prior to raviam <br /> LIPID urpr QM.Y ' <br /> EHD 49-09 <br /> Received Time Mar . 18. 2013 10 : 06AM No - 2584 <br />