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03/07/2013 12:02 FAX 805 964 <br />URS--Corp-Santa Barbara <br />DATE <br />arbara <br />DATE RECEWED <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East 116zefton Avenue, Stockton, CA 95205-6232 <br />'n I.e k'41 Tglpphone: (209) 468-3420 Fax: (209) 4640138 Web: www.sjgov.org/ehd- <br />r <br />UB.LIC RECORDS RELEASE APPLICATION <br />BUSINESSIAGENCY: IRR� 06 <br />W 4 -ILL V-0) --'Itloo ciTyisTATEop... <br />[a 0001/0001 <br />END LOG NUMBER <br />oa-rmj <br />PHONE (1): (b�� ��L — �0&5 � PHONT(2) );AC "QqWX5�(FACSIMILE: q3117 <br />TENTAT-IVE*APPOINTMENT DATE: Time: <br />(Please allow il) business days from date of application submittal -*Tentative only- must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUES 5125 FEE C OR&BE-el( ONLY) -REQUEST PROCESSED IN 3 BUSIN SSjDAyS <br />SIGNATURE OF APPLICANT DATE, 377/)-7 <br />Electronic Information: [] List E] Map;- Description: <br />Specific Data Range of Information Requested: From KLA_1 . to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />2_�DERoizouiio TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FAcILITY1VEHIcIr- <br />VO-T ER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT - .1 -' <br />WASTE TIRE �;feS F1'&nl -3 <br />DERGROUND TANK (MONITORINGIREMOVAL) E] FOOD FACILITY ❑ DAIRY V k"6 j -(3--1 <br />--;5 <br />=FA000vEGROUmD TANK 4--", [:]CHICKEN RANCH( DOG KENNEL E]WASTEWATER TREAYMENT PLANT <br />US WASTEIHAZARDOUS MATERIALS CK, E] MoTEL/HoTEL EIPUMPER TRUCKIYARDICHEMICAL TOILETS <br />E1TIERED PMnmFACILITY [:] P_00LISPA [:] LAND USE APPLICATION SITES <br />El TATTooftDY PiERciko RCOMPLAINTIRESPONsE RECORDS [:1 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AvAiLAaLE FOR REVIEW: -MONDAY-FRIDAY 3:00 Am -5:00121111 (Excl-poiNG HOLIDAYS) <br />I. List uR to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file fte MUST be selected. Fax to (2091 ARA.M-19 -Al—f-of above. Address <br />ranges will not be areceived after <br />3:00 pm will be prQ���� ­'�, �11 <br />� <br />� �(� )xImafolyten (110) <br />2. The EHD will notify L <br />days after receipt �polntrnents <br />should be schedule <br />6 <br />3. A file that Ii activel; �E oplication may be <br />submitted when the <br />4. Any file not retume the applicant. <br />Future file reviews 1 -4 4__ EHO USE ONLY"* <br />EH 14l .06 <br />Received Time Ma r. .7. 2013 1 1:'54AM No. 2511 3-15-13- Pled Lkhdwcvl�,64-, N <br />Alll_ Aa �t'fl, <br />a <br />W, <br />'A <br />to <br />Specific Data Range of Information Requested: From KLA_1 . to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />2_�DERoizouiio TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FAcILITY1VEHIcIr- <br />VO-T ER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT - .1 -' <br />WASTE TIRE �;feS F1'&nl -3 <br />DERGROUND TANK (MONITORINGIREMOVAL) E] FOOD FACILITY ❑ DAIRY V k"6 j -(3--1 <br />--;5 <br />=FA000vEGROUmD TANK 4--", [:]CHICKEN RANCH( DOG KENNEL E]WASTEWATER TREAYMENT PLANT <br />US WASTEIHAZARDOUS MATERIALS CK, E] MoTEL/HoTEL EIPUMPER TRUCKIYARDICHEMICAL TOILETS <br />E1TIERED PMnmFACILITY [:] P_00LISPA [:] LAND USE APPLICATION SITES <br />El TATTooftDY PiERciko RCOMPLAINTIRESPONsE RECORDS [:1 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AvAiLAaLE FOR REVIEW: -MONDAY-FRIDAY 3:00 Am -5:00121111 (Excl-poiNG HOLIDAYS) <br />I. List uR to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file fte MUST be selected. Fax to (2091 ARA.M-19 -Al—f-of above. Address <br />ranges will not be areceived after <br />3:00 pm will be prQ���� ­'�, �11 <br />� <br />� �(� )xImafolyten (110) <br />2. The EHD will notify L <br />days after receipt �polntrnents <br />should be schedule <br />6 <br />3. A file that Ii activel; �E oplication may be <br />submitted when the <br />4. Any file not retume the applicant. <br />Future file reviews 1 -4 4__ EHO USE ONLY"* <br />EH 14l .06 <br />Received Time Ma r. .7. 2013 1 1:'54AM No. 2511 3-15-13- Pled Lkhdwcvl�,64-, N <br />Alll_ Aa �t'fl, <br />a <br />W, <br />'A <br />