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FROM ERAS E--i------t-1 , 1­0 (TUE>OCT 20 2009 14$/ST. 14.23/Na.71500000738 P 1 <br /> D �MffED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 2 0 2009 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRUNMENT Mvfne: (209)468-3420 Fax:.(209)464-0138 Web: www.sjgov.o <br /> ERVIrES PUBLIC RECORDS RELEASE APPLICATION <br /> 4? <br /> APPLICANT: � BUSINESSIAGENCY: '* <br /> ADDRESS: j r �� CITYISTATEIZIP: t <br /> PHONE(1): 7 -w PHONE(2): �� �Jd '�s {'� FACSIMILE:-St 0— 's 86 —S-3-t I <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-•Tontative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQUEST-$115 FE SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I6 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> _ FILE ADaRESS EHD USE ONLY <br /> Streat Street Name City ❑Unit 1 <br /> 1. CA(ay& a L-ane— tV G © NO c0/719 • V <br /> 2. y Sys ` Y. <br /> 3. y 7 '&3 l Liti G �t �I <br /> 4. nit' <br /> 5. <br /> 6• Unit4 <br /> 7. <br /> ❑Unit 5 <br /> 9. <br /> 10. "044 1 ❑Unit 6 <br /> Specific Date Range of Information Requested: FX <br /> to <br /> ENVIRHEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> .OTHER CLEANUP SITE{NON-LOP) FACILITY ❑WASTE TIRE f�, <br /> NDERGROUND TANK(MONITORINGIREMOVAL% OGKENNEL ❑DAIRY "'^ ' I <br /> 5IA7ARD0US WASTE GENERATOR V\ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 116/0 l/vol <br /> ❑TIERED PERMITTED'FACILITY L]MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS r! <br /> ❑ <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARL AVAILABLE FOR REVIEW.: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <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 12091464-0138 or mail to thqaddress 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 aider 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 /> EHD USE ONLY <br /> t7rj. <br /> 3 <br /> END 48.06 8127/09 <br />