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08/26q/2009p/] 11j::58 2094728654 INSITE ENVIRONMENTAL PAGE 01/01 <br /> REISI1 V EU SAN JOAQUIN COUNTY -. EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 2 6 2009 600 East Main Street, Stockton, CA 95202-3029 `} <br /> ENVIRONMENT HEOlephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e J3 (_ <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION 11 <br /> APPLICANT: l/n BUSINESSlgGENCY: Jns.'k-c .v� !L(�+nlmardrA�t <br /> ADDRESS: `L—� ►r1St��1 CltylSfatelZlp � I C44 OL522IEI <br /> PHONE(t): '{-I 2.- S(p.rjO PHONE(2): y"t 1 - $'1 5Z FACSIMILE: N 7 7- '9&54 <br /> TENTATIVE*APPOINTMENT DATE: Time; <br /> (Pkaise allow 10 business days from date Of application Submittal-"Tentative only-mast be confirmed) <br /> CHECK BOX TO EXPEDITE REQE 105 FE CASH OR EC ONLY -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronlc Information; ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. �. {�, At,� S .1YI ❑ Unit 1 <br /> 2. <br /> ❑ Unit 2 <br /> 3. <br /> 4' Unit 3 <br /> 5. <br /> 6. It 4 <br /> 7. <br /> 8• ❑ Unit 5 <br /> 9. <br /> 10. C) Units <br /> Specific Date Range of Information Requested: From to !j <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tN <br /> ERGROIIND TANK(UST)CLEANUP SITE(LOP) I7 HOUSING ABATEMENT <br /> ER CLEANUP SITE(NON-LOP) F SOLID WASTE FACILITYNEMOLE V 1 <br /> ERGROUNDTANK(MONITORINGIREMOVALW 0DOG FACIIE� 0WASTE TIREARODUS WASTE GENERATOR 0 CHICKEN RANCH DAIRYRED PERMITTED FACILITY � 13 MOTEUIiOTE4 0 WASTEWATER TREATMENT PLANT U•/, �/I� U' <br /> O TATTOOISOVY PIERCING O PUMPER TRUGKlYARDlCHEM TOILETS D <br /> 0 MEDICAL WASTE FACILITY 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 OrHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RE KIN - MONDAY-FRIDAY 8:00 AM-5:O0PM - ExcWDING HOut)Ays, <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 A 4-0138 or mail to the dtlress' dica d above. Address <br /> ranges will not be accepted-For additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:ODpmwillbepcocessed the next-business - ---------- — <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 immedlately 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 b review. <br /> EHD USE ONLY <br /> US <br /> END 748-D6 8104/08 , <br /> PUBLIC RECORDS RELEASE AFP FORM <br />