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FrowM�a'r"ccuus H. Bole & Asso0es 530+633+0119 1202009 16:12 #140 P.001 <br /> �C CIE " EID SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> t 0 7 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> T� 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONMtNT HEALTIRlephone: (209)468-3420 Fax: (209)464-0138 Web: WWW,sjgoV.o <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION 7 <br /> APPLICANT: / `7� n/-� BUSINESS/AGENCY: q/y,/I 1-1111"'/,ADDRESS: <br /> -1111"'/, <br /> ADDRESS: -/ 2 &0 ck !/ri✓te City/State/Zip //lr2�- <br /> PHONE(1): !2j -o//-7 PHONE(2): -?O-V21-- Cg/ate tI`Uld <br /> ' FACSIMILE: _`T,S�n "(o33D//9 <br /> TENTATIVE'APPOINTMENT DATE: �� //u,- me: ?X30 <br /> (Please allow 10 business days from da a off applica0 submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTS L DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City b�Unit - <br /> 1 <br /> 01-1 <br /> � 2 �a$� ' i/ Uzi 5 SN tz <br /> �•_ 3' � ��—iv` r• F it !� <br /> 5. El <br /> 6. 7 ' on " 5T T- til N0 y� unha <br /> 7. �� 14/ &1a ch/9q it ,55�� <br /> 6. 0 L 1 / '`7"1' 0 ff?"NOiAn�j3UJ /0!_ units <br /> g. -- w - <br /> Unit 6 <br /> 10 C/ter Cv // De5 Mn co <br /> Specific Date Range of Information Requested: From <br /> / a ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> :UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT s/OLID WASTE FACILITY/VEHICLE �© •1\ /\��[\I <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE ,V•\I,ia,t •„`u\ t <br /> �AZ <br /> I- _ GROUND TANK(MONITORING/REMOVAL) 0 D00 KENNEL 0 DAIRY _ \ <br /> ARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 11 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 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 pe(is)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the END. 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 Nle 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$105 deposit prior to review. <br /> EHD USE ONLYT) icull — <br /> :)y—p <br /> j <br /> EHD 48-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />