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` FROM ERRS Environmental, Inc_ (THU)MAv 12 2011 'S:S9/ST. 1S:59/No.7600000490 P t <br /> DATE RECEIVED EHD LOG NUMBER <br /> RE�����® SAN 6JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> 1�1AY i. 2 <br /> Zajjephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> NME <br /> ANT <br /> ( VA9 e BUSINESS/AGENCY: <br /> ADDRESS: C { 33 CITY/STATEOP: ov <br /> PHONE(1): 7• <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submnral-Tentative only-must be confirmed) <br /> [:]CHECK BOX TO EXPEDITE REQUEST-$1 E(C H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE s=1 9^ 1 l <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street s Street Name City Unit t <br /> 2. 14 74 W Lam- r 1ok nit 2 !/ <br /> 3' WPSS pori MC a 44iff7l�j aw dw. <br /> (J 4' Unit a <br /> 5. <br /> 8' nit 4 <br /> 7. -- <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES .�� �/ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑ <br /> SOLID WASTE FACNJTYNEHK:LE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE I ,U�,,II J <br /> L2 <br /> NDERGROUND TANK[:1 DOG KENNEL El DAIRY <br /> ATARDOUS WASTE GENERATOR d� ❑CHICKEN RANCH L1WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACam ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE 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 type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file typo MUST be selected. Fax to(209)464-0135 or mall 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 END will notify the applicant if any END files 0XISL An appointment for review will be confirmed approximately tan(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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHD USE ONLY <br /> EHD I606 07125110 <br />