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03/07/2011 MON 9: 33 FAX 2094682999 SJC Public Works 2001/001 <br /> ,1r_t[�MVED <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 'Z 0 7 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONMENTAL Telephone: (209) 468-3420 Fax: (209)464-0138 Web: wvvw.sjgov.org/ehd <br /> RER?I,' AL I-lEAITH <br /> rll/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _)1pr/1 G r14r tYb/DK/�5 __ _�__BUSINESSIAGENCY: >�� <br /> ADDRESS: /0/ L• '7 le��OY� VC-' CittyylStaterzip S C t�7�p X11,-A _-9-2a"- <br /> PHONE(1):( ,Or1 �� b q 9".30O 1 PHONE(2): RI/ —yGO gooy FACSIMILE: S — <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 EXPEDITEZUA�r <br /> ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE <br /> Electronic information: ❑ List❑Map-Description: <br /> FILE ADDRESSEHD USE ONLY <br /> Street# // Street <br /> Name ( City �^ T <br /> 1 5���� F Gtn(O✓L ^ �G���o �� F0.trV�t f i7r G�� � Unit 1 <br /> `2 © �L -- - ll �1, N)unt�31a/5 Unitz <br /> 3. bb — --- l t l - (,0(4 <br /> Unit 3 <br /> 4. L l Escac <br /> 5. ©O C7 l l l t <br /> Unit4 <br /> s. y �— r� ( l�; <br /> 7. 106 5 S� ®_�—"—+✓� L( ------- unit s <br /> —Lv i Nrd dam' <br /> g' p NC W Unit 6 <br /> Z F— <br /> 40. 3 Sce,(org <br /> . — e-4d �l �! <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> _�%UNOERGROUNO TANK(UST)CLEANUP SITE(LOP) ZFHOUSING ABATEMENT KSOLID WASTE FACILITYNEHICLE <br /> �THER CLEANUP SITE(NON-LOP) )CLFOOD FACILITY C1 WASTE TIRE <br /> P'UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG,KENNEL DAIRY <br /> �-IAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT 3- <br /> 11 TIERED PERMITTED FACILITY ❑MOTELIHOTEL )Sr-PUMPER TRUCK/YARDICHEM TOILETS l <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA $LLAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> 1 . 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> I EHD 411-06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />