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01/22/2013 . 10:48 9254260186 BUREAU VERITAS PAGE 01 <br /> rte'°# EHD LOG NUMBER <br /> � DATE RECE�� NU <br /> �' I <br /> C5� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> rI?rone: (249) 468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd <br /> cn��` <br /> y �� PUBLIC RECORDS RELEASE APPLICATION i <br /> APPLICANT: 1 , <br /> .�If�-��. �'j�Q�l1 Bl!<SINE531AGENCY: <br /> ADDRESS: .1�;7-_&yi,Jd.l Xh.odaa CITY/STATEMP., <br /> PHONE (1): tFACSIMILE: <br /> c2):.64.D&—M=? �T <br /> TENTATIVE*APPOINTMENT DATI✓- Time. <br /> (Please allow 10 business days from data of application submittal-'Tentavva only.mu9t be confirmed) <br /> ❑CHECK BOK TO EXPEDITE REQUEST-$ S FEE(CASH OR CHECK DAILY)-REOUEST PROCESSED IN 3 BU (NESS DAYS � <br /> SIGNATURE OF APPLICANTDATE <br /> Electronic Information: ❑ List C1 Map—Descrip Ion: <br /> FILE ADDRESS EHD USE ONLY i <br /> Street# Street Name City []Unit 1 <br /> 2- .�0 Unit 2 t <br /> 377, 1 a _ ) <br /> 4• Ito. <br /> vw&4-61,1) fUnit 3 .J <br /> 6. P / <br /> �❑Unit 4 � <br /> 7. <br /> a• `f ❑Unit 5 <br /> 9. <br /> 10• .❑ Unit li <br /> Specific Data Range of Information Requestad: From to <br /> Au <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> f UNDERGROUND TANK(UST]CLEANUP SITE(LOP) ❑MEINCAL WASTE FACILITY �SOLID WASTE FACILITYNEHICLE <br /> Pq OTHER CLEANUP SITE.(NaN-LOP) ❑Housltlo ABATEMENT WASTE TIRE <br /> UNDERGROUNo TANK(MONITORINWREMavAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK CHICKEN RAN,-W DOG KENNEL EK WASTEWATER TREATMENT PLANT <br /> HA?Awotl9 WAwElHAzARnou5 MATERIALS ❑MOTELIHOTEL ❑PAMPER TRUCKIYARDICHEMICAL TOILETS i <br /> TIERED PERMRTFD FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY Pir;RciNa ❑CAMPLAINTIRESPONSE RECORDS ❑OTHER(PLWE.'SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAE3LE FOR RwEw: MONDAY-FRmAY 8:00 AM•5:0015M (EXCLUDING HOLIDAYS) <br /> 1. List un to tan addresses in the space above. Select the type(s)of tiles from the list above by checking the appropriate <br /> box(es). At least one fife type MUST be selected. Fax to 12491464.4 38 or mall to the address Indicated above. Address i <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHE). 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 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 /> shouTd be scheduled accordingly. <br /> 3. A file that is activaly 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 he reorganized by EHD staff at the expense of the applicant <br /> Future file revieWs by the same applicant may require <br /> ia St 2S deposit prior to review. J RI <br /> t�kiCi II i ' <br /> j i > <br /> !{ € 1 1 { <br /> EH44"S 914/72 } <br /> Received Time ,tan. 22. 2013 10:46AM Flo, 2136 <br />