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04/24/2009 12:56 SIE' ELTA CONSULTANTS LLC � 1209464017 1 NO.955 1?01 <br /> I <br /> EHO LOG NUMBER <br /> f1 <br /> E <br /> H � ��E�f SAN.1 OAQUIN COUNTY <br /> �J �C U ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2 4 2009 304 East Wcber Avenue, 3ra Floor, Stockton, CA 95202-270 <br /> Telephone:(209)468-3420 Fax:(209)464-0139 Web:www,sjgov.or <br /> ENVIR(MENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMITI <br /> APPLICANT: G t3U8iNE3SlAGENCY: <br /> ADDRE85: , 2 I <br /> G FACSIMILE: `�' a�-_9Sol <br /> PHONE(1): �� �3 - 4-K 7- _PHONE(2): <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`rantatfve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST.$03.00 FF ASN0 HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT S k'4-oLA- DATE _ '��- <br /> UNIT DISTRIBUTION ❑ Unit 1 C7 Unit 2 0 Unk 3 ❑Unit 4 0 UMt 5 0 Unit 0 ❑ Othev(elecb'onlcfllatslredps) <br /> FILE A13DRESS KHD USE ONLY <br /> Street It Street Name_ Qlry . <br /> 1. LIS o law- k r <br /> 2. i S <br /> 3. <br /> 6. — <br /> 7, <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES hlf�L �JYVt'-� <br /> l�l YQ/A <br /> UNDE.RaROUND TANK(UST)CLEANUP SITt3(LOP) HOUSING ABATEMENT 17 SOLID WASTE FACILITYIVEHICLE0 WAsTE TIRE <br /> THEK CLEANUP SITE(NON-LOP) 0 FOOD FACILITY / <br /> M [7 DOa KENNEL C1 DAIRY <br /> �UND ItDou3 ND TANK GENERATOR <br /> /REMOVAL)✓\ 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> cruAiARD0u5 WpA7E GENERATOR D PUMPER TRUGdYARDICHEM TOILETS <br /> 0 TimEn PERMITTED FACIUTy ❑MOTEL MOTeL p LAND USE APPLICATION SITES <br /> 0 TATTOoI1300Y PIERCINO 0 POOUSPA <br /> C7 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:001'M - EXCLUDING HOUDAY$. <br /> 1. List up to ten addresses in the space above, Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least one filo type MU$T be selected. Fa z to(209)464.0138 0Vil to the address <br /> in ve. Address ranges will not be accepted for additional assistance with file addresses,contact <br /> the END.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any EHD files exist- An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The Piles will be held for a maximum of five business <br /> day's for review. Appointments should be scheduled accordingly. <br /> 3. A file that Is actively being worked an by END staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by END staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> i <br /> o <br /> 115 - - <br /> Ale 6 <br /> cHcs"A" <br /> 1H4fOs <br />