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/ 08/10/2011 16.9 FAfi_-�, TREADWELL & ROLLO 001 <br />EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />�Tt4 600 East Main St. Stockton, CA 95202-3029 <br />GI�� `gUN '{T ephone: (209) 468-3420 Fax: (209) 464-0138 Web: www_sjgov.org/ehd <br />�5i PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:t `0.� BUSINESS/AGENCY:('�a�.t,� I d- lin i� o <br />ADDRESS: S�S^ /ulrn�r. Qt.� S Ise, q CITYISTATEIZIP: S F <br />PHONE (1): S ,;-� - SZ3 6 PHONE (2): FACSIMILE: �� (�� �1S-S -:5-20 <br />TENTATIVE` APPOINTMENT DATE: qe Z Time: <br />Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />❑ CHEGK BOX TO EXPEDITEOR CHECK ONLY) - REQUEST PROCESSED 1N 3 BUSINESS DAYS <br />R ST - $ CASH <br />SIGNATURE OF APPLICANT DATE!' t 0 -- I <br />Electronic Information: ❑ List ❑ Map - Description: <br />— �{ �j S <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit <br />_ l <br />Street # <br />Street Name <br />City <br />❑ WASTE TIRE `� 3 • I 1 <br />UNDERGROUND TANK (MONITORINGIREMOVALCX\ <br />HAZARDOUS WASTE GENERATOR/Y <br />❑ Doc KENNEL <br />El CHICKEN RANCH <br />❑ DAIRY l -1� <br />WASTEWAYER TREATMENT PLANT <br />Unit 2 <br />2. <br />PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />3. <br />❑ POOLISPA <br />- <br />Unit 3 <br />4. <br />Unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />unit <br />10, <br />5� <br />Specific Date Range of Information Requested: From <br />— �{ �j S <br />to <br />ENVIRONMENTAL <br />EK UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />HEALTH DEPARTMENT FILES <br />❑ HOUSING ABATEMENT <br />LJ SOLID WASTE FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ WASTE TIRE `� 3 • I 1 <br />UNDERGROUND TANK (MONITORINGIREMOVALCX\ <br />HAZARDOUS WASTE GENERATOR/Y <br />❑ Doc KENNEL <br />El CHICKEN RANCH <br />❑ DAIRY l -1� <br />WASTEWAYER TREATMENT PLANT <br />TIERED PERMITTED FACILITY ,✓ V \ <br />❑ MOTELIHOTEL <br />PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />M TATTOOIBODY PIERCING r� <br />❑ POOLISPA <br />LAND USE APPLICATION SITES <br />Ll MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List up 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 type MUST be selected. Fax to (209)464-0138 or mail 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 atter 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 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 a $122 deposit prior to review. <br />FNn IlAr nut v <br />J w 'e -- <br />rr � <br />W-IMMUR R5 AM. —mlown <br />END 48-06 1 , , , h, (e I <br />U11"llu <br />