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• Pago 3 of 3 2013-02-15 '19:50:55(GMT) '18885733982 From:MlaM1ele Pe�Kina <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONNIENTAL HEALTH DEPARTMENT <br /> FEB -+- � <br /> . 201: Stockton, CA 95205-6232 <br /> �, 1868 East Hazelton Avenue, <br /> 1eiethc 3e (209; 68-3420 Eax: (209'} vvw <br /> 0438 Web: w.sjc�cv.offaMu <br /> `PUBLIC RECORDS RELEASE APPLICATION <br /> : IR 1 t ( h0 LP Q� 1 /�S 1 BUS{NESSIAGENCX: <br /> APPLICANT � <br /> ADDRESS: -1356 1OSeOlnv.. 1►,,n 30D CITY/STATEIZIP: Y)U\N4r,' g(j <br /> PHONEFACSIMILE:1 -9/ffy-573^_3PHONE' t: <br /> 98 <br /> TENTATIVE*APPOINTMENT DATE: a— — Time: <br /> (Please allow 10 business,days'c'om da of p foaifon nuaiultal-'Te Native wuy-must be Confirmed) <br /> �I CHECK.BOX TO EXPEDITE.REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSDAYS <br /> SIGNATURE OF APPLICANT — DATE <br /> ' Electroniclnfoonatfon• [7 List)] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name Citi' Ll Unit 1 <br /> 7. l� C.`7'�'C��- Z- <br /> 2. L.Lf O c� t t/\-Z Unit 2 <br /> 3. t .1 ' S§6 <br /> 4. 5.-150o C 14,MzI'Lzyb urritI <br /> /file �Bl�e &bc- <br /> 7. <br /> unit 6 <br /> 8. ❑i,Unit a <br /> @D. <br /> SpeCPtic.Dala Range et informatfcrn Reques FO <br /> EN <br /> to <br /> ENVIRONNMENTAL HEALTH DEPARTMENTFiLES Oi�DIRiASTEFAcilSTYNEHID'..E <br /> JNDERGROIIfD TAMX(OST)CLEANUP SITE(LOP) ❑MEDICALWASTE FACILI TY <br /> ❑Houstw ABATEMENT ASTETIRE <br /> OTHER CLEANUP SITE(NON-LOP) DAIRY <br /> NDERGROuim TAW(MONIr0RINCIREh10VAL) ❑FOOD FACL:IY ❑WASTEWATER TREATMENT PLANT <br /> ABOVEGROUNDTANK ❑CHICKEN RANCHI DOG KENNEL <br /> M��EtIHGr�' (�PUh7PERTRUG}CIYARClCHErdICALTOILETS <br /> liftZARDOUS bVASTEIHAZA°.DOUS MATERIALS 0 LAND USE APPUOATtON SITES <br /> ED PERMITTED FACILITY [I POOLISPA <br /> 0 TATr001-BODY PIERCING <br /> TIERGOMPtAtNTIR_sPONsE RECORDS ❑OTHER,PL@.ASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Li"3 to ten addresses in the space above. Select the type(s)of fifes from the list above by checidng the appropriate <br /> box(es). At least one fife type MUST be selected. F r rn(2091 484-01'38 or mall to the address Indicated above. Address <br /> ranges x-11 rat be accepted-for addiNonai assistance with file addresses,Contact the EHD. Apph.,ations received atter <br /> 3:00 pm will be Processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exlsL An appointment to <br /> review v.111 ire confirmed approximately ten(i0) <br /> days after receipt of application. The fifes will be held for a maximum of five business days for review. Appointments <br /> stivuld be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review- Anew application may be <br /> ff <br /> submitted when rile fife is Valfable. <br /> 4. Any Tile not returned In the same condition as released will be reorganlzed by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a 5125 d posit prior to review. <br /> 77 7.77 <br /> 47 <br /> t�C4fdgptr�Vt4i8di?y.Sidfi`^�'r''{�:'€�ctr�#f�tsttryeme�',,�:::':•. ',. '. :.: ... . .. ..:�:-.==- 814157 <br /> EHD 4$-08 <br /> Received Time Feb. 15, 2013 11 :50AM No• 2326 <br />