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X04/27/2009 16:16FF'fAX 916 817 4747 R D R ENGINEERING 0001 <br /> EV • EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> APR 2 12009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> NT HEAR 600 East Main Street, Stockton, CA 95202-3029 <br /> ENV NT (209) 468-3420 Fax: (209)464-0138 Web: www.sjgo <br /> ? sE� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> /� <br /> APPLICA . = �`S� � � BUSINESS/AGENCY: <br /> ADDRESSIF-0Np.f Dl� Rn>. I _ City/Statelzip �o L..S'O t-'1, C:A- —t�v y�}�d <br /> PHONE(1I �I lo'$I�1•'1,-12•$ PHONE(2): FACSIMILE: �TI10'�' t^)- q-��}-^7 <br /> TENTATIVE`APPOINTMENT DATE: +5/5 /Ocl Time: <br /> (Please allow 10 business days from date of applioation submittal.'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST.$105 11 ,,FnnEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNAT RE OF APPLICANT DATE <br /> Electro Ic Information: ❑ List[] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> treat S Street Name city Unit 1 <br /> y 13 t'j, NWY 1111 Ahfo, <br /> .Y '")�' W, Hiv "1`j `J`ipG(Gfv^� UJ OL-`0. �' Unit <br /> mol N' iiHAf �I°I sroG <br /> A! q, G( N. �W `1`1 S'ro -oI�1 @✓tl�' /, Unita L� <br /> 5. -1 b3 N, Yiw !1q S'�oG.I�bIJ Sr UJ/j1 It4 ice/ <br /> i 0.5-7 N, Hwy 'IM ScoCK1-oJ �Ht <br /> 7• ❑ Unit 6 <br /> 8. <br /> 9, I ❑ Unit6 <br /> 10. ° <br /> Specific Date Range of Information Requested:From to I' ` <br /> _/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1 <br /> aLl_INDER ROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT M SOLID WASTE FACILIYIVEHICLE <br /> MOTHER LEANUP SnE(NON-LOP) Cl FOOD FACILITY C2 WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) 173 DOG KENNEL 13 DAIRY V^ <br /> ❑HAZAR OUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY MMOTELIHOTEL 171 PUMPER TRUCK/YARD/CHEM TOILETS <br /> r7 TATTCK JBODY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY Cl OTHER(PLEASE SPECIF)() <br /> q WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY•FRIDAYS-DOAM-5:DOPM -EXCLUDING HOLIDAYS- <br /> 1. List 4p to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box( S) At least one file type MUST be selected. Fax to(209)'464.0138 or mail to the address indicated above. Address <br /> rang s will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 in will be processed the next business day. <br /> 2. The 4HD 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 /> shou�d be scheduled accordingly- <br /> 3. A fit that is actively being worked on by END staff may not he immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Anyle not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Futu a file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> .q <br /> N i, <br /> 4 Oq Itf6�-$ Hw Irb1J 1 p d / <br /> EHD 49.0, B/0410 PUBLIC RECORDS RELEASE APP FORM <br /> i <br />