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rom:GE^O Syntec^ConSnitEFax:(916 56 -9498 &o: 2094640138@rcfax.con Fax: +12094640138 e 2 of 2 8/12/2013 10:05 <br /> RWY SAN JOAQUIN COUNTY IR EHD LOG NUMBER <br /> AUG 12 2013 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMEMALA&Ahone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.orglehd <br /> PERMITISEFMCES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:�1rrr+ !`(w {. . <br /> BUSINESS/AGENCY: laeor4vVi'nc o 5 <br /> ADDRESS: CITYISTATE(ZIP { c. � <br /> PHONE(1): `7JG....(>5� `S�3 PHO j- (2) �1�) 64g7, ja27 FACSIMILE: (a3} g�Z <br /> TENTATIVE APPA.¢NTMENT'4A1 :' (Z tri- 2 iT 3r s*adA&'r Titfi2 Z _ <br /> IPlease ail**4bualnesa dayatmm date.of radon su9mlttat-`Tontailva.only muatbe'con I edj <br /> CHECK BOX TO EXPEDITE REQUEST (CASH OR.CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE .1. ". .. .. <br /> 'd� ... <br /> Electronic Information: ❑ List❑Map.-Description: <br /> FILE,AI DRESS <br /> Street# i Street No me City <br /> z. . . .- t�� �7� <br /> ` : pp �.-F ..:�; u' .._.� ❑Unit 2 nry/ <br /> 3' 1t�CSGI kr c. gal. .. () . <br /> 4. 2`t�aUnit 3Id <br /> „ 1� <br /> { <br /> 5. <br /> nit4 <br /> 7. <br /> _..__.— 1`--n--- <br /> s <br /> 10. --` ❑Unit 6:1 <br /> Specific Date Range of Information Requested: From .. ,.. to <br /> cc--�� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> rgr�Yr UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY 0SOLID WASTE FACILITTIVEHICLE <br /> MOTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®.UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ©WASTEWATER TREATMENT PLANT <br /> f` 11pi,R04Up;OASTE/HATARDOUSMATERWLS ❑MOTEUHOTEL ElPUMPER TRUCKNARDICHEMICALTOILETS <br /> L.J TfER&PERMRTED FACILITY - ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PMEXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of Itles from the list above by checking the appropriate <br /> box(es). At least one rile type MUST be selected. Fax to(2091464-0138 or mail 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 rev(aw 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 may not be.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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may rRquire a 3125 deposit nrlcr%' rrviaw. 'B=... HD Igr ONLA <br /> W <br /> ��soo�7s'"pr,D�(1i� by SCnff PPR Cgmplecc e�rf Namf:; <br /> EH048�6'y —9rgn2- <br /> Received Time Aug. 12. 2013 10:05AM No. 3852 <br />