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FROM ERAS E,,-i ronm-ntal Inc (WED)OCT 7 2009 14:02/ST. 14:01/No. 7500000B88 P 1 <br /> DATE REUE <br /> SLE � n EHD LOG NUMBER <br /> Illf��—llu'I�\��I�' SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OU Q 20Gq 600 East Main St. Stockton, CA 95202-3029 <br /> "Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e <br /> ENVIRUNMENT HEALRi PUBLIC RECORDS RELEASE APPLICATION 7 W3 <br /> APPLICANT: SINESS/AGENCY: <br /> ADDRESS: ( �3 3 1 <br /> `' , .1W/STATE/ZIP: <br /> PHONE (1): PHONE (2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: "' Time: <br /> (Please allow 10 business days from date of ap li ation submittal-' "4f.i .', nI must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST- 115 (C H OR CHECK ONLY)-REQSCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I0—7—6l <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City <br /> /Vu W1,71 F]unit-1 <br /> ---,3C%'rC � - � r - DS f T� <br /> 2' _ �i�c SCG Init 2 <br /> - 3. °3 T Cry e� k;(k- <br /> o03 <br /> 6(1- <br /> 4. <br /> G PinWler- Ln Unit3 <br /> 5. 3f0/ <br /> 7. � — <br /> XUnt <br /> 8. _ ❑ unit 5. <br /> 10. <br /> (o«� ❑ <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> HNDERGROUND TANK(MONITORINGIREMOVAL)�( ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR a "` ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION STIES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(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)4640138 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 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHD 48-06 <br /> 8127109 <br />