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11/07/2012 13:27 8052399309 SIERRA DELTA CONSULT PAGE 01/01 <br /> ji-EGOVED EHD LOG NUMgGR <br /> SAN J®AQUiN COUNTY <br /> NOV <br /> 07 NII ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,CA 95205-6232 <br /> (10NMENTALH one: (209)468.3420 Pax:(209)464-0138 Web:www.sjgov.org/ehd <br /> @ERMITIS'ERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 1BUSINESWAGENCY, StCRRA <br /> APPLICANT. <br /> �� �"�'�' '�^ <br /> ADDRESS: �v. '.Z AII-sToy 4VA CITYrSTATEOP.. �s <br /> PHONE(1): SSI-2 z9-•W.s/ P14ONE(2): <br /> FACSIMILE: <br /> TENTA77VE"APPOINTMENT DATE: I,l f 9 /► Time: I S <br /> (Please mHow 10 business days from dstD 01 eppgcatlon submittal---reMBtfv®only-must be eorttirenad) <br /> ®CHECK 13OX TO EXEE1Drm REQUEST.$125 FEL( CHECK ONLY)-REQUE8T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �° _ DATE _- <br /> lEleeMnic Informattlon: . ®List Cl Maw_Descdntioa: <br /> cg— _ FILE ADDRESS EHD r rSe ONLY <br /> Street# SO*"Name CRY jUn <br /> F-it <br /> 3. `( - ( -�2� It <br /> a. <br /> 7. <br /> 9. <br /> 10. <br /> Unite <br /> Specific Vubm Range c f kniormation RQq : From to <br /> ENVIRONMENTAL WEALTH DEPARTMENT FILE <br /> §— <br /> WABTE FACILmrNEtl E <br /> 1�.UNDPRGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WALE FACILITY (� <br /> OTHERCLEAmwSrm(NoN10.13) ❑HOUSING ARATEWNT ]WASTE TIRE 3 1105> � <br /> UNDERGROUND TANK(MONITORNWREMOVAL) [l FOOD FACILITY F1 DAIRY it' I1''q , <br /> ABOVEGROUND TAW ❑CHICKEN RANCH/DOG KEWL O WASiEti/YA T TMEW PLANT <br /> I'a*DousWA$TWHAZAi wUsW-ERIALS Q MATELMOOfEL Q PUmPERTRUCKIYARDICHEMICALTOILIETS <br /> Q TIERea•PT:Wffi t:o FACILITY Q POOUSPA Q LAND USE APFUCATKNI SITES <br /> El TATTOO MOOY PIERCING COmpLAiNTIREsPONSE RECORDS Q OTHER(P3.EME SPECIFY) <br /> WELL ANIS SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00VM(EXCLUDING HOUDAYS) <br /> 1. Wit' a to Qnad�ire rz-ea In the space above. Select tha typa(9)of fl'les from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax totto9E.MgFl to addreesS Indieat d gbay, Adtl <br /> rm <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received atter <br /> 3:00 pm will be processed the next business day. <br /> 2. The Erin Will notify the applicant if arty EHD files exist. An appolntrnent for rovlew wilt be confirmed approximately ten(10) <br /> days.after recmipt of application. The fikm wilt be held far a.maximum of five buaineas days for mvlew. Appointments <br /> should be scheduled aceasrdingTy. <br /> 3. A file iS acttv®ty being work�-on by EHD staff may not be Iiritnedistely available for r8v +- Anew application may a <br /> submitted when the file is avaMle. <br /> 4. Any file not returned in the same condition as released wail be reorgaTfted by EHD Staff at the expense of the applicant. <br /> Future file resviews by the sar"applicant may requite a$125 deposit prior to review. *•-WXi n AREA-EHD USE ONLY <br /> i3-IZ. - ` ee. <br /> E3 Records provided by Staff-PPR Complete.staff Name; <br /> E AU-06 914112 <br /> Received Time Nov, 7, 2012 12:29PM No. 1573 <br />