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02/05/2010 15:03 9168630 STANTEC PAGE 01/01 <br /> RECEIVEDSAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 0 5 2010 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.Sjgov.o51e <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION �� <br /> P _ <br /> APPLICANT: J BUSINESS/AGENCY: f t Co <br /> ADDRESS: �Q + 5y;f JQ(� CITY/STATEIZIP: <br /> PHONE(1): PHONE(2): FACSIMILE; 9/6 <br /> TENTATIVE*APPOINTMENT DATE: t_s4rZ' ry .22 dl0 Time: 9;�ara <br /> (Please allow 10 businoas days from dam of appl catibn aubmlttal••Tentative only•must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUE -$116 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313U INFS S DAYS <br /> t SIGNATURE OF APPLICANT DATE -r 0 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streets Street Name Clry <br /> 1' lea "e INaY 5�ac on U� <br /> 2. l y �l �S Lam;/�c� SrtrEEe��� Stak1dn <br /> 4. _w �21tC BBV y e� U7 <br /> S. <br /> T6. <br /> 7. nits <br /> 8. <br /> g ❑ <br /> units. <br /> 10. . <br /> ❑units <br /> SPoelfrc Date Range of information Requested: FromAn 4 to r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES [ <br /> pl UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYA1F.HICLC L <br /> rER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIREERGROUND TANK(MONITORING/REMOVAL)k ❑DOG KENNEL ❑DAIRYARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> El TIERED PCRMITTED FACHNY ❑MOTEUHOTEL El WASTEWATER TREATMENT PLANT 7j . <br /> E3 TATTOOIBODY PIERCING ❑POOUSPA ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> El MEDICAL WASTE FACILITY El LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo to tettaddresses in the space above. Select the type(s)of files from the list above b checking the a <br /> box(es). At least one file type MUST be selected. Fax to(2091464• y e appropriate <br /> ranges will not be accepted-for additional assistance with file addressesrcontact the EHD. 9 indicated ica Applicationsreceived. afters <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$116 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHb E exLY <br /> EHD4a•0a <br /> 61STNA <br />