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Sent By: ORSWELL & KASMAN, INC. 4 626 932 1807; Dec -15-09 9:40AM; Page 1/1 . �D EHD LOG UMDE SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT u`IL, 1 5 2009 600 East Main St. Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgleh ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION Da=RenlT/c9at.1Irrl Q - -_ -- ,APPLICANT: pk I `YDGZ. k`vSGCtt BUSINESS/AGENCY: ADDRESS: 4wtS w��,1 I �`�� CITY/STATE/QIP: vt' f- h 41014 PHONE (1): ,S �2 — [Sz PHON (2)' FACSIMILE: (,� c� =� $0.7 TENTATIVE' APPOINTMENT DATE: Time: (Please allow 10 buainsas days fro to of application sdbmittal - •Tenfadve only - must be confirmed► 1. _J CHECK BOX TO EXPEDITE REL,TUE51 - $11b FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 DUSIN SS DAYS SIGNATURE OF APPLICANT DATE Electronic Information: ❑ List ❑ Map — Description: — -- FILE ADDRESS EHD USE ONLY Street # Street Name City Unit 1 -- - - No u:h�- le; 1. a59, 5.. West C r cY W. loc K a V1 i ve I l% (' to U y 2. a L+ 41 �n1�.s� . a 1-Y . Wa Y `J ac,1��s.r Unit z b�'✓ 3 I � a y . Y� .... CG�f { Sko`k V% 5 0E�,n�d ' 4.6. �LJyY l 1vcK vlsix... n� `�.�1, Unit 3 �.a7_ y S• 1 Al Cnc ova nit 4 g I CJ units _. 9. ❑ Units Specific Data Range of Information Requested: From to ENVIRONMENTAL HEALTH DEPARTMENT FILES' UNDERGROUND TANK (UST) CLEANUP SITE (LOP) El HOUSING ABATEMENT El SOLID WASTE FACIUIYNEHICLL 3; OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY E] WASTE TIRE ( 0 I UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL p DAIRY L) (� I FIET,roo/BODY ZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH El WASTEWATER TREATMENT PLANT RED PERMITTED FACILITY E3MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS PIERCING ❑ POOL/SPA [] LAND USE APPLICATION SITES ❑ MEDICAL. WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:OD AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses In the space above. Select the type(s) of flies from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464.0138 or mail to the qddross indicated above. Address ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 3.00 pm will be processed the next business day. 2. The EHD will notlfy the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHO staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $115 deposit prior to review. 5. If you need further assistance, please contact Diane Martinez, at (209) 468.3426.