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JUN-22-2009 10:46 From: To:12094640138 Pa9e:111 <br /> EHD LOG NUMBER 4J11lII iL}� <br /> SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 2 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464.0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENT HEA!TH <br /> �a <br /> PER.-MIT/SERV!CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � \ (nke ��0.nGru BUSINESSfAGENCY: —r-P f cin <br /> ADDRESS: I C D t<(_o'Z M . I I 1 IL rA-f--) _ Citylstatolzip k('V� f-A Oa t Qn�A <br /> PHONE(I)' NE( —FACSIMILE! <br /> TENTATIVE*ow APPOINTMENT DATE: Qo� Z S� t^�' L'I fmg <br /> (Please all10 business day$from date of application ve submittal-•TentadOnlymust he oonfirme ) <br /> L'CHECK 90X TO EXPEDITE REQUEST-$106 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS <br /> SIGNATURE OF APPLICANT S�{ /lEQ (tLp I_ia /lGL1M DATE (0/ZZ/ffj !Afe <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street• Street Name City ❑ Unitl <br /> 1 1 L•1 U _ALr.pD(-+ W" �+ OCK� or7 Py F- <br /> 2. oz ,oEs, Rr Cr <br /> N 4. _/ Q.__ ( jirr unite <br /> Wa 5. <br /> 6. <br /> 8. 4 <br /> El unit s <br /> 9. ❑ Units <br /> 10. 1 1 <br /> Specific Date Range of Information Requested:From _ _ l W to <br /> --// ENVIRONMENTAL HEALTH DEPARTMENT FILES �I1t'�n <br /> M-115UNDERGROUNDTANK(USTI CLEANUPSITE(LOP) C1 HOu$INGABATEMENY ❑SOLID wASTe FACILITYNEHICLE <br /> / <br /> LYOTNER CLEANUP EUTE(NON.LoP) 0FOOD FACILITY ❑WASTE TIRE ) <br /> MI 4tIDERGROUND TANK(MOMTORINCIREMOVAL) ❑Doo KENNEL 0 DAIRY IIIMMM /��/DQ <br /> M-AAURDOUS WASTE GENERATOR K 1]CHMEN RANCH O WASTEWATER TREATURNTJ?,, T / <br /> TIERED PERMITTED FACILITY 0 MOTELMOTEL ❑PUMPER TRUCKIYAR01 STs <br /> ❑TATTOOI806Y PIERCING O POOLISPA 0 LAND USE APPLICATI <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) :9 Alto <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 0:00 AM-6:00PM - EXCLUDING HOUR <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the approp <br /> box(es). At least one file type MUST be selected. Fax to(209!1464-0138 or mail to the address indicated above. Add <br /> ranges will not be accepted—for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2, The END will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days akar 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 END staff may not be Immediately avallable for review. A new application may be <br /> submitted when the file is available, <br /> 4. Any file not returned in the some condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require it$105 deposit prior to review. <br /> END USE ONLY <br /> q' U <br /> wavZoaI <br /> fel2q&Q • i 301 5 382fefAV7 If W_ <br /> 07 A-i 600/ S <br /> EMD IMI 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />