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Dec 21 09 12: 45p Reilly 541 -593-3800 p. l <br /> UED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> F`r..`, 1 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 LLC? <br /> -NV�iR0NM'NT HEALRiiephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org e <br /> PERW `SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BU_ SINESS/AGENCY: <br /> ADDRESS: CITY/STATEIZIP: ,-�� L� C jj <br /> PHONE(1I: //'E�1 � PHONE � ., LLA ot_�.._._ FACSIMILE:�Lj 512'- A<:.:, <br /> C <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 EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ) Z'Zl (U� <br /> Electronic Information: ❑ List❑ Map—DesC ' "on: <br /> FILE ADDRESS EHD USE ONLY <br /> Street* Street Name City <br /> Unit 1 <br /> A-V-ooe�� <br /> Oji <br /> 2. C/'r- �C�nR2 <br /> 3. <br /> 4. <br /> Unit 3 <br /> 5. �! <br /> 6. <br /> _ nit4 <br /> 7. �\� 9 <br /> units <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILrrYNENCLE <br /> HER CLEANUP SITE(NON-LOP) �7 El FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONrrORINGIREMOvAL) 1/\ ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY( ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TAT-r00/BODY PIERCING ❑POOUSPA -N-CAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILrTY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up tq 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(709)464-0136 or mail to the adlress lndlcated 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$116 deposit prior to review. <br /> 6. If you need further assistance,please contact Diane Martinez,at(208)4683426. <br /> EHD USE ONLY <br /> tJ (A (.cam e i1 I-IM wan)57W <br /> EHD 48-06 8!27109 <br />