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11/19/2012 14:45 9166486688 ADR PAGE 02/02 <br /> EHD LOG NUMSi- <br /> � R <br /> RR%E Z!fff SAN JOAQU[N COUNTY a. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ®� ZQ7� 1866 i=ast Hazelton Avenue, Stockton, CA 95205-6232 t <br /> Talephorte: (209)468-3420 Fax:(209)464-0138 Web:v+rww.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. ��fy� l +ILA" BUSINESSIAGENCY: <br /> ADDR58S: 115 CITYISTATEIZIP: � GA ©l.-8 i6 <br /> PHONE(1): 1.� —415y�iZ�� PHON (2): )6-461-3LFACSIMILE:` 1 b 4°{� <br /> TENTATIVE*APPOINTMENT DAT E:_�1I`2,-7 112, Time: <br /> (Pfeaae allow40 buslnssa days from rlda ofapRoatlon suhmlit�Tsnfaflve*ply-must be .n rmod) <br /> Xt'CHECK BOX TO EXPEDITE RE VEST $125 i (CASH OR CHECK ONLY)'-REQUEST PROCESSED IN 3JUSINESS DAYS <br /> SIGNATURi=OF APPLICANT a PATE <br /> 1=lectrontc information: 0 List❑Map—Description...- <br /> FILE <br /> DescriptionFILE ADDRES6 EHD USE ONLY <br /> Street# Street Name City D Unit 1 <br /> COOK <br /> a P: tj <br /> 2. �� L4i .Jll 1`t �; r,` A 1$��, J (��(3unit2 <br /> 4. 5 1 `e c o lulnit3 1! <br /> 5: 1— ' Ir� <br /> 6. <br /> 7. <br /> lo, <br /> SpwolfloDato Range of information Requested: From , Y to pR 4-164-T— <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)Et l:mv?SITE:(LOP) HOUSING A13ATIIIINT 54 SOLID WASTE FAC�ILrNEN LE <br /> IOTHER CLEANUP SITE:(NON-LOP) ❑FOOD FACILITY TNASTETIRE,�}/,e ,- t <br /> UNPERGROuNn TANK(MONITORING/REMOVAL) O DOG KENNEL ❑DAIRY wm t$ '1—';CI-(Z <br /> HAZARDOUS WASTE GENERATOR El CHlc(( N RANCH ❑WASTMATER TREATMENT PLANT <br /> TiERED I'amiuw FACILITY El MOTEIIHOTEL PUMPER TRUCK1YARDICHEMICALTOILETS <br /> TAMOIRODY PIERCING ❑POOIISPA ❑LAND USE APPLICATION SiTES <br /> '@ MEDICAL WASTE FACILITY ;9 COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WEU,AND SEPTIC PERMIT REc;cI 3 ARE AVAELAmE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> 1, Llst uR to ten addr_s�_s®s in the apace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At Ieast one file type MUST be selected. F x to(2091484.01 B or all to the address indicated above, Address <br /> ranges will not be accepted-for additional assistancev4th file addresses,contact the EHD, Applications received after <br /> 3:00 pm wi)I be processed the next business day, <br /> 24 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 herd for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A fila that is aotively 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$125 deposit prior to review. <br /> EHD US5 ONLY <br /> EHD 48.00 tltf <br /> Received Time Nov, 19. 2012 2:31PM No. 1664 <br />