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Dec. 8. 2008 5:41PM Advanced GeoEnvironmental . No- 3796 P, 1 <br /> DATE RECEIVED j� EHD LOG NUMBER <br /> Ifl1E�JL�T�� V SAN JOAQUIN COUNTY <br /> �C, �/ V ENVIRONMENTAL HEALTH DEPARTMENT <br /> 029 <br /> ur.0 0 y-foo$ 600 East Main Street, Stockton, 38 Web: ww. <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or I d <br /> ENVIRONIuIENTNEALTN PUBLIC RECORDS RELEASE APPLICATION <br /> PI y <br /> PE API&A T`! III f `ar�I r/ ,16A cy idlkY SUSINESS(AGENCY <br /> ADDRESS: l32 .5 kAL!„-_- c. .a Cltylstateizip _S4w—b�� CA <br /> PHONE(1):014 j) W—16005'0/ PHONE(2):� fl� 123- t4I5 _FACSIMILE: <br /> TENTATIVE”APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal•'Tentative only•must be confirmed) <br /> CHECK EOX TO EXPEDITE REQ T 105 FEE SH OR HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT .-. DATE 12 <br /> Electronic Information: ❑List Q Map—Description: <br /> f <br /> _. FILE ADDRESS _ EHD USE ONLY <br /> ..... _....., __. <br /> . I <br /> Street f Street Name CRY, ✓ ❑ Unit 1 <br /> to <br /> 4. <br /> 2. <br /> Unit 2 <br /> __.. . �I/--l5''- -' ` _...- <br /> 3. <br /> 4. Z. e _ 13F4ilF'te3c�' �tJUUnl�3ui', „ <br /> e. o fi <br /> Alf <br /> i>. nit4 <br /> 7. <br /> -._.. ----- PO<nit 5 <br /> 8. <br /> 9. <br /> --. _. _. —... ❑ Unites <br /> Specific Date Range of Information Requested:From to -3 � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �)kS/o/ <br /> NDERGROUND TANK JUST)CLEANUP SITE(LOP) eHOUe1NG ABATEMENT 71 SOLID WASTE FACILITY C tl <br /> OTHER CLEANUP SITE(NON-LOP) 71 FOOD FACILITY O WASTE TIRE <br /> I / „ <br /> fUNOERGROUND TANK(MONITORINGiREMOVAl)OC 13 ODD KENNEL ❑DAIRY ✓b" ITij/DL/(�F <br /> ❑HAZARDOUS WASTE GENERATOR ' ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLR <br /> TIERED PERMITTED FACILITY ❑MOTELiHOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> TATfOOtSODY PIERCING y❑PPOOLISPA r ❑LAN CTG- PPLICATION/$.ITELS� �► <br /> 71 MEDICAL WASTE FACILITY F IJTHER(PLEASE SPECIFY)R'�tM`��'t TrW� V <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-$:UDPM _ EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the Space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mall to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. 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 /> should be scheduled accordingly. <br /> 3. A file 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 some condition as released will be redrganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$106 deposit prior to review. , <br /> EHD USE ONLY <br /> - 0 T : I N n y1 <br /> wS, s - <br /> HVJ uJdS <br /> co ovr ( N. <br /> EHD 48-08 $/(M/OH P�ULCoE RELEASE P FOR <br /> I-7-1-1-or AAPIiotAm ac'lCd r ) /e PtQJ 14VJ6'fe 6Ot ,fi� M <br />