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11/07/2012 13:27 8052399309 SIERRA DELTA CONSULT PAGE 01/01 <br /> p[FaCdFj\JED <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> NOV <br /> 07 ZW ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,CA 95205-6232 <br /> LtONMENTAMi one: (209)468-3420 Fax:(209)4640138 Web:www.sjgov.org/ehd <br /> pERM1Tt6ER�CES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT' �.c C"z L-WGC^ BUSINESS/AGENCY: Si6RRk fir.rA-- <br /> C}TY/STATEI2IP: <br /> Aaal�Ess: ' ��sss' N. �,�/,�srvr/' •�v� <br /> PHONE(1): 559 2 Z9-AWS"/ PHONE(2): <br /> FACSIMILE: � <br /> TENTATIVE"APPOINTMENT DATE: 11 i /1Z- Tune: 11 �e1^- <br /> (Plgase atl3rw 10 business days ftfrm date o1 app'Icatton submittal-"Tenzeftw only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REOUEST-$125 FEL( CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SiGNATURE OF APPLICANT � . _ ®AT E�Ir/�/r Z-- <br /> Electronic information, ®List E] Map—Description: <br /> - FILE A13DR�S EHD ts&e ONLY <br /> Street easel Name City h 1 <br /> Al <br /> Z. $t tis' i rA.D Gb0 y$3 _— unit 2 !! <br /> 3. <br /> t u„d 3 <br /> 4. -0 <br /> .�,. <br /> s. tMv nitc <br /> $. unit s <br /> s. <br /> 10. Unit B <br /> Specific(>a�Range of information R®queowd: From O m�0/LJ to e%S" <br /> ENVIRONMEWAL HEALTH DEPARTMENT FI <br /> 19 UNDERGROUND TANK(UST)CLEANUP SiTE(LOP) ❑MEDIM WASTE FACILITY Q SOLiD WASTE FACILIT1rIV E <br /> IOTHER CLEANUP Sim(Nott-LOP) ❑HOusiNG ABATEMENT E]WAAM TIRE 3 (� ►A�+Z <br /> UNoEAoRoUND TANK(MONRORNWREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABMGROUNDTANK ❑CHICKEN RAN-09 DOG KEWL [oil WASiEWA T TMwr PLANT <br /> gj H{1XAR00USWASTEIHA7ARDOu5MA7'MALS ❑M07EIIHWEL E]PUMPERTRUCKIYARDICHEmiCALTOMS <br /> ❑TIE=Pewm1TED FACILITY POOLISPA ®1-AND USE APPI.ICATKM SITES <br /> ❑TATTOOi IDDY PIERCING COMPLAiNTiREsPONSE RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PEMIT RECORDS ARE AVAILABLE IFOR REVIEw: MoNDAY.FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOUI)AYS) <br /> 1. Leet iIQ to�Qn ad resses in the space above. Sslec4 the type(g)of files from the list abava by tdleeking the appropriate <br /> box(es). At least ore file type MUST be selected ax to(209}464-09 8 or rna)I the address Indicated above, Aadness <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be pmeesead the next business day. <br /> 2. The BID V411 notify the applicant If any EHD Oleo exist. An appoiabrient for rdvlew will be confirmed approximately ben(10) <br /> days,afEer cecelpt of appileatton. The files wilt be held fnr a.maximum of five bustntess days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file t)taL is aotiv®1y b®Ing w�lor clic oil N EHD su may n®t tie im <br /> lneifia ly avanabte for sev►evr.-Anew application may a <br /> submitted when tfie•file is available, <br /> 4. Any file not mtxkned in the same condition as released viii be reorganlzed by EHD staff at the expense of Nie appikarrt. <br /> Future file reviews by the same applicant may require a$175 depoMit prior to mvview. ",WXW AREA•FHa USE ONLY <br /> i3�(Z Pe I a -2 <br /> 13 Records provided t>y StaPf-Pi'R Complete.starrNam®: -- <br /> EPW da-M flIR11Z <br /> Received Time Nov, 7. 2012 12:29PM No. 1573 <br />