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05/01/2012 11: 32 41598a,,.:f1 NINYO f�00RE v PAGE 01 <br /> DATE RECF=NEB EHD LOG NUMBERSAN JOAQUIN COUNTY <br /> FS ��ED ENVIRONMENTAL. HEALTH DEPARTMENT <br /> R <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ,01"`Te1ephone: (209) 488-3420 Pax: (209)404-0138 Wets:vvmi.sjgav,org/ehd <br /> f lR �1M-NTALHEAL_�" <br /> irl <br /> Fav►cEs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 19 1&C f— �� �' c �°j9 EUSINESSIAGENCY: 91`1,�7 vc tAoat%r 1EV <br /> ADDRESS: i e4'r, G DI T YISTATE/ZIP: <br /> PHONE (1):5(D G 33 --9 6q - PHCINE (?): 9-rd �-1 FACSIMILE: -9to G 3 i� S 6 rF cS <br /> TENTATIVE*APPOINTMENT BATE: tMe-Lir .9 Time; 13 a /'C47 <br /> (please allow 10 business bays from date of appli�n submittal-"Fentkfve only-must be confirmed) <br /> ❑CHECK Sox TO EXPEDITE REOLIFST•S125 FEE(CASH OR CHECK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT — DATE <br /> Electronic Information: E]List 0 Map—Description: <br /> FILE ADDRESS E14D USE ONLY <br /> Street# Street Name City Unit t <br /> t< <� 1JF `� _ n Unit z <br /> 3. &4` Pte` ;f< cv<�+�� v;� �vS' 21 <br /> I� <br /> 4. -76 7 7 f•,` /�- n'r r0 Unit 3 <br /> ZZ r .':. :� a 3� les (90ve- ISS I <br /> # 12 ,3 LSU it 4.. L%Nv <br /> '"Please respond as soon as possible. s11'h2- <br /> I need to notify applicant during week of 5/14/12 if Unit e <br /> EHD has files for listed addresses or not. <br /> ,Ej Unit 6 <br /> Specific Date Range of Information Requested: From 100- <br /> ENVIRONMENTAL <br /> 0ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNQERGROUND TANK(UST)CLEANUP SITE(LAP) HOUSING ABATEVENT ( SOLID WAST@ FACILITYI1/I:HICLE <br /> ®OTHER CLEANUP SITE(NON-LAP) ©FOOD FACILITY WASTE TIRE <br /> UNAERGROUND TANK(MomrroRINGIREMOVAL) Q Doc.KENNEL Ll DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL ToiLETS <br /> ❑TATTOOIBODY PIERCING ®POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WA5TE FACILITY ❑COMPLAINT RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERNIIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Ust urs to ten_ad_d es in the spate above. Select the type(s)of files from the list above by chocking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 9 454-013$ mail to th dress-ino1Q,112d above. Address <br /> ranges will not be accepted-for additional assistance with file addrnsses,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 END 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 /> $. A file that Is actively being worked on by EH1D staff may not Ian 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 EHO staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> r J _ ,r�f 7- � <br /> /,/�� Jr�-f� �� `' f`: i 7��. :7✓�.1� (`, 1�'�i��F.l•ID�U`4NL�_�.�11�f���� �i� l� -/� /).�%,/ rt` <br /> 7 i <br /> END 4"13 <br />