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From:Marous H. Bole & Asso es 530+633+0119 12 '2009 16:12 #140 P.001 <br /> U URWEDEHD LOG NUMBER <br /> SAN a1OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ® 7 2��9 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONMtNT HEALTRlephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.o <br /> PERMIPSERVICES PUBLIC RECORDS RELEASE APPLICATION 4 <br /> APPLICANT: v /h BUSINESSIAGENCY:�'////(Zd- <br /> T _V <br /> ADDRESS: �C�Y 'ro cls !///�`� City/State/Zip C�/fPtL �l i14-/ <br /> PHONE(1): ,S ✓ 6/,� //d PHONE 1 Id FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: L��/] Time: 9"30 <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 7l%�i��-�� c.yO DATE <br /> Electronic Information: ❑ List(] Map-Description: <br /> FILE ADDRESS EHD_USE ONLY _ <br /> Street# Street Name City j��E✓❑ Unit 1 <br /> Z• Unit 2 <br /> I °? / <br /> _ �a S' � �z � Ori��e ' " u�' � l `-� <br /> a. / �5 Unit 3 <br /> 5. <br /> ❑ Unit 4 <br /> 6. tNo7. <br /> 10 �� <br /> Unit 5 <br /> 8. — �� —_— '21 G `� Np LWZZ 1 3 c0 S/fl <br /> 9. D .-� — -`�_'/ L 1jUnit 6 <br /> 1 O. A'11 tv 6i;�4 06 /Uo 00 <br /> Specific Date Range of Information Requested: From to 1 <br /> J <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ✓�, UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE �©`"�k�` �1 <br /> 4a-OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 WASTE TIRE V ry t` `.\"�\ <br /> Q'U� ERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY c \ <br /> IAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5: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)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 /> .I4—o _ — <br /> ,. <br /> EHD 48.06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />