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UZ/Za/Uy lU: 4bAM Kass and Kass Lata Offices 6505790760 p. 01 <br /> EHD LOG NUMBER <br /> L' uL �L EDLD <br /> SAN .IOAQUIN COUNTY <br /> Lid (C�I LU1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> 'E.B `n�' ' 20 09 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgo e <br /> 200.- <br /> ENVIRUNNIENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Michnel DnnglaS r/n Bra rllav Kass BUSINESS/AGENCY: Kass & Kass Law Offices <br /> ADDRESS: 520 S . El Camino Real , Ste. 810 City/State/Zip San Mateo , CA 94402 – <br /> PHONE(1): (650)__5.7.9-0612 PHONE(2): (650) 766-1247(Mike)FACSIMILE: (650)579-0760 <br /> TENTATIVE"APPOINTMENT DATE: as Soon as possible Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 17 CHECK BOX TO EXPEDITE REQU 5105 FEE H OR C LY)- EC!UEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2/23/09 <br /> Electronic Infort-nation: ❑ List❑ Map–Description: <br /> FILE ADDRESS _ _ EHD USE ONLY _ <br /> Street — Street Name City <br /> nit 1 <br /> 1 19256 I N. State Route 99 Frnt '. Acampo ; iO ' <br /> 2 i nit 2 <br /> _ I <br /> 3. <br /> 4. Unit 3 <br /> Unit 4 <br /> 6.7.T <br /> I I ❑ Unit 5 <br /> _8 I <br /> 9. <br /> _ __ __ ❑ unit 6 <br /> 10. , <br /> Specific Date Range of Information Requested: From 01/01/0 8 — to _ present <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE J y� <br /> W OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> M UNDERGROUND TANK(MONITORING/REMOVAL)O\ ❑DOG KENNEL a DAIRY <br /> M HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH a WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS 7 V <br /> 0 TATTODIBODY PIERCING 0 POOLISPA KI LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY G?OTHER(PLEASE SPECIFY) 1 e a k <br /> 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 /> 3 9 <br /> EHD 8-06 8/04/08 n_ //� PUBLIC RECORDS RELEASE APP FORM <br />