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06/03/2008 09:51 FAX 530243165>4�_. CH21_HILL s` 01002/002 <br />EMD LOG NUMBER <br />DATE RECEIVED SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA:95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.0 / <br />i <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: n ( r. BUSINESSIAGENCY: _..91L2 llll <br />ADDRESS: 25 25'r f4 0r- <br />PHONE <br />V PHONE (1): k 3"�'T2+1 , PHONE (2): 1 - FACSIMILE: <br />TENTATIVE' APPOINTMENT DATE:' b Iz t 8 Time; 1,200(Please allow tan business days from date of application submittal - *rMtative only -must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUES'T•.-,5,98,-DD�F�,E (CASH OR CHECK ONLY) - R80UFST PROCESSED IN THREE BUSINESS DAYS <br />eIn_kIATitnG nE ADDI ICANT W{ 41 -Yd V I/ I DATE 6it,Jc8 - <br />Electronic Information: [I List L] Map- Description:) a <br />to <br />EHD USE ONLY <br />FILE ADDRFSS <br />Streat # <br />- Stmet Name <br />CJ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />CIFANUP SITE(NON•LOP) <br />11 Unit 1 <br />y� <br />Unit2 <br />2. <br />3143-4 <br />tfpornko <br />.S 'erme4 <br />5}zcK:for <br />3. <br />32Uz. <br />S• E flora�tA - <br />' <br />ElMOTEUHDTEL <br />0 UMPERTRUCKIYARDICHEMTOILETS <br />'LAND <br />., n <br />❑�POOUSPA <br />IN NO$"A'L <br />nit <br />5 <br />— <br />S- EI_Docado <br />�! <br />s• <br />7• <br />91Omrad0 ` <br />8, <br />032 <br />[3 Units <br />nit <br />Specific Pate Range of Information Requested: From <br />to <br />ENVIRONMENTAL <br />I I <br />HEALTH DEPARTMENT FILETS <br />❑ HOUSING ABATEMENT <br />WSOLID WASTE FACIUTYNEHICLE <br />CJ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />CIFANUP SITE(NON•LOP) <br />FOOD FAaLnY <br />WWASTE TIRE <br />FTHER <br />NDERGROUNO TANK(NIONITORINc4REMOVAL) <br />O DOG KENNEL' <br />DAIRY <br />CCCCMMiiii AZAROOUS WASTE GENERATOR <br />0CHICKEN RANCH <br />O WASTEWATER TREATMENT PLANT <br />�ERED PERMITTED FACILITY <br />ElMOTEUHDTEL <br />0 UMPERTRUCKIYARDICHEMTOILETS <br />'LAND <br />❑ TATTOOBODY PIERCING <br />❑�POOUSPA <br />IN NO$"A'L <br />USE APPLICATION STIES <br />MEDICAL WASTE FACILITY <br />OTKER(PLEASE SPECIFI'( <br />II%A5}-L <br />WELL ANO SEPTIC PERMIT KEOORDS ARE AVAILABLE FUR K&MW • NIUNv l •r Lrvvnr u:w rvri^a.wr.- �....�......... .......... •..• <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 (2091464-0138 or mail to the above address. Address ranges will <br />not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will <br />be processed the next business day.i• : x <br />a <br />2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten <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. i - <br />3. A file that is actively being worked on by the EHD staff may not be immediately available for review. A new application <br />may be submitted when the file is available. I - <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 858:00 deposit prior to review. <br />EMDUSE <br />ISE hNl_Y <br />END40481029roT PUBLIC RECORDS RELEASE APP FORM <br />