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^02/05/2010 15:03 916861O¢30 STANTEC . PAGE 01/01 <br /> MEMV � O 0 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 0 5 2010 9)4 East Main St. Stockton,01 895202-3029 <br /> www <br /> Telephone: (2D9)488-3420 Fax: (209)464-0138 Web: vrwwusjgov.o50Z--.�j <br /> ENVIRONMENT HEALTH CORDS RELEASE APPLICATION <br /> P PUBLIC RECORDS J• <br /> APPLICANT: &'r' �[Sjd11 11 BUSINESS/AGENCY: jLo tot C°JLf.(L1,'nM LOr,O <br /> ADDRESS: 9D Adr�� L��Zr–ja clTrisTArFIZIP:�'ent�h Cr Qy� rA 95 <br /> PHONE (1): PHONE(2): FACSIMILE: 91G <br /> TENTATIVE'APPOINTMENTDATE- E d10 Time: 11 <br /> (Please allow 10 business days from dam of app cation submittal-'Tentative only-must be confirmed) '—�•- <br /> ❑CHECK BOX TO EXPEDITE REQUE -$116 FEE(CASH ORCH CK ONLY)-REQUEST PROCESSED IN 3 BU <br /> IN DAYS <br /> k SIGNATURE OF APPLICANT DATE '4 .r 0 <br /> 1. Electronic Information: ❑List❑Map–Description: <br /> FILE ADDRESS 8HD USE ONLY <br /> Streets Street Name city rr <br /> alf e W4 On <br /> < 2• 14 _s_ tali. Sti e Stakton T 0 <br /> a. _lam[ er 51x ea (A_ 66s,Vo 6019 \ <br /> 5. nit3 <br /> 6. X <br /> 7. — nNa UUU <br /> S. <br /> 8 ❑Unit s <br /> 10. <br /> Specific Date Range of Iniormetivn Requested: <br /> Volta <br /> d: From �,,� to r <br /> tpI ENVIRONMENTAL SING ABH DEPARTMENT FILES <br /> ❑ <br /> pl UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT ❑SOLID WASTE FACILRYIVF,HICL1, �T tit <br /> �HAZATHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> RDOUS <br /> NDERGROUND TANK(MONFrORINGIREMOVAL) ❑DOG KENNEL ❑DArRv FlJ I <br /> WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT /✓,/J, <br /> ❑TIERED PERMITTED FACIUTY ❑MOTEUHOTEL <br /> ❑TATTOGIBODY PIERCING ❑PUMPER TRUCKICARON SITES ALTDILETS <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(P LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RHVIEw: MONDAY-FRIDAY 8:00 AM-6:00 (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(as), At least one hie type MUST be selected. Fax to(206)464.0138 or mail to the adtlrees indicated above Address <br /> ranges will not be accepted•for addltlonal 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 mlaased will be reorganized by EHD staff atthe expense of the appllcant. <br /> Future file reviews by the same applicant may require a$116 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHb E ONLY <br /> W. <br /> EHD M-OG <br /> alziror <br />