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{Ir�LC-,� r1�111�+/IJP/j lel. 1 <WED)MAR 10 2010 12:66/ST. 12:55/N,000000321 P l <br /> JOAQUIN COUNTY EHD LOG NUMBER <br /> MAR 1 U 2010 SAN <br /> iLRONMENTAL HEALTH DEPARTMENT <br /> ENVIRUniIVI ENT HEALTH �u. °t' 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES Val <br /> one: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd [ , � <br /> PUBLIC RECORDS RELEASE APPLICATION / f f( o� <br /> APPLICANT: QU &W_ t Q BU, NESS/AGENCY: � 9-r1V(r`onme40 <br /> ADDRESS: I S3,3 8 511 cnI1_�' 7� ATE/ZIP:_ atT l C- <br /> PHONE(1):.SIO-or N-]-I8 + 6 wPHONE(2): CSIMILE:SIO <br /> TENTATIVE*APPOINTMENT DATE: ,3- I� -I, T' e: <br /> (Please allow 10 business days from date of applkatlOn submittal-*Tents ( e confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$115 F AS OR CHECK ONLY)-REQUEST PR SSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE-3 - 10 -( 6 <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> #4. <br /> Street Name City Unit 1 <br /> . F 2MOR SnGr G HJT Z ND 4 �Ie <br /> P10'YV� S�"P� -S 0 Q ❑Unit 2 /V <br /> . <br /> 6. <br /> Unit4 <br /> t <br /> ❑Unit 5 <br /> 9. <br /> 10. f `` <br /> ❑Unit fi / <br /> Specific Date Range of Information Requested: From to IVr <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOUD WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> UNDERGROUND TANK(MONITORING EMOVAL)� ❑DOG KENNEL WASTE TIRE W <br /> f` ❑DAIRY uhf Il/I� <br /> HAZARDOUS WASTE OENERA70R [I CHICKEN RANCH <br /> El TIERED PERMITTED FACILITY ❑WASTEWATER TREATMENT PLANT <br /> ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOOBODY PIERCING ❑POOLISPA <br /> El MEDICAL WASTE FACILITY ❑L1H0 USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468.3425. <br /> EMDl19E ONLY <br /> 0$ d 3 <br /> r - : 61)VOOOVS r4� <br /> EHD/e-06 <br /> arlr/e9 <br />