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EHD LOG NUMBER <br />DATE RREECE(�IV(EDD �}�% SAN JOAQUIN COUNTY <br />u �11—I--1�1L=� V ED ENVIRONMENTAL HEALTH DEPARTM 'NI' <br />AUG 1 1 2009 00 East Main St. Stockton, CA 95202-2708 qls�ls Telephone: (2209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e)ENVIRONMEN r HEALTH <br />PEWIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: L �t-r o'S� 6� i (� BUSINES <br />S/AGENCY: <br />ADDRESS: 2.59 N CITY/STATE/ZIP I` ( to o r --t <br />02k 4536 <br />PHONE (1): 20 4 — Sq 9 — 'L 10 t PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST .$115.00 FEE (C OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE S-//-02 <br />Jb� G tact A>J <br />Electronic Information: ❑ List ❑ Map - Description: <br />From <br />EHD USE ONLY <br />FILE ADDRESS <br />Street # <br />Street Name <br />City <br />El Unit 1 <br />1. <br />D! jUNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />M 4AS6A)'S DRI 5TOr—KTnN Av6 <br />/� <br />K 0f%j' 4 >A <br />❑ Unit <br />Unita <br />2. <br />13 FOOD FACILITY <br />.4,1sFCmitl✓D -s`r.QEr N•W65 <br />/ <br />3. <br />❑DOG KENNEL <br />23 S• s7�ro�,' <br />6 <br />4. <br />❑ CHICKEN RANCH <br />❑ WASTEWATER T13 REATMENT PLANT <br />ritT/ <br />5. <br />❑ MOTEL/HOTEL <br />1:1 PUMPER TRUCK/YARD/CHEM TOILETS <br />Unit 4 <br />6. <br />0 LAND USE APPLICATION SITES <br />• MEDICAL WASTE FACILITY <br />7. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br />❑ Unit 5 <br />8. <br />- <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: <br />From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />D! jUNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />O HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITYNEHICLE <br />�• <br />OTHER CLEANUP SITE (NON -LOP) <br />13 FOOD FACILITY <br />11 WASTE TIRE <br />/ <br />�A// <br />UNDERGROUND TANK(MONITORINGIREMOVAL){^ <br />❑DOG KENNEL <br />0DAIRY <br />6 <br />Cl HAZARDOUS WASTE GENERATORQ` <br />❑ CHICKEN RANCH <br />❑ WASTEWATER T13 REATMENT PLANT <br />ritT/ <br />TIERED PERMITTED FACILITY O< <br />❑ MOTEL/HOTEL <br />1:1 PUMPER TRUCK/YARD/CHEM TOILETS <br />• TATTOO/BODY PIERCING <br />❑ POOL/SPA <br />0 LAND USE APPLICATION SITES <br />• 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 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 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 $115.00 deposit prior to review. <br />Fun IISF ON[ Y <br />***If you need further assistance lease contact Diane Martinez @ (209)468-3425'directly. Thank You*** <br />2 <br />e )V200s <br />EHO 46-06 <br />