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03/02/2011 12:05 FAX _ Ij001/001 <br /> RECENEU SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> CSAR Q 2 2011 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax. (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> P- <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I,L Ja.'WAa0S BUSINESSIAGENCY: r ^ <br /> ADDRESS: TAM &VLr CITY/3TATF1ZIP: &AL9AM9TH_ 6A q-;8'L1 <br /> PHONE(1): q l6 ,%a PHONE(2):(QL( b",jq"Z2 IV FACSIMILE: 4(6 3 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tantadve only.must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUES -$122 FE ASH OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7- <br /> Electronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> titreet o Street Name City ❑Unit 4 <br /> I'. ' Zana"',_ <br /> 2 {2.- SAiAQo)%r eTT"( LA44L— ❑Units <br /> 3. foo saac_IN�rn t- N� sr�t�-,rx�-4 3sa� <br /> 4• 2'U b T7115wace-T Si Aswr. Z6nlla <br /> s. 2�'t..'�,'L 4Tt..ir S'Ttt [- S7aLk�- q�l� <br /> 61 lerunite 1010 <br /> 7. <br /> $ ._._..._...�_ ❑Unit S <br /> 9 <br /> 10. 13 Unit ti <br /> Spoelfle Date Range of Information Requested: From _ W <br /> ENVIRONMENTAL HEALTH DEPARTMENT FII-ES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NOW LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TiERF.D PERMITTED FACILITY ❑MOTEL1140TEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATT001HODY PIERCING ❑PODL/SPA ❑LAND USE APPLICATION SiTES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONI)AY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> i. List up to ten addresses in the apace above. Selact the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. F x to 2O9 4134-013 the address' . Address <br /> ranges will not be accepted-for additional assistance with We addresses,contact the tEHD. Applications received after <br /> 3:00 pm will be processed the next buslness day. <br /> 2. The FHD will notify the applicant If any EHD 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 /> 3. A Tile 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 require a$122 deposit prior to review. <br /> E"o use ONLY <br /> ENP 4@�B DTr�1 U <br />