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JUN-4-2009 10:23A FROM:GEOPHAB NU 2695690295 T"'4642138 P.2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> IL El'r� L If U I l 600 East Main Street, Stockton, CA 95202-3029 <br /> ' `� ��felephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> 3731 <br /> JUN <br /> n 0.4^172009 PUBLIC RECORDS RELEASE APPLICATION <br /> ENVi F14 &W. H Or BUSINESS/AGENCY: E"�✓ <br /> PEJWA&RV 3 -r City/State.-., / S <br /> PHONE(1): �9 Oe'L�/ 7 PHONE(2); ----���y� FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 7_110'r r Time: <br /> (Pleats allow 10 bull nsas days from date of application submittal--Tanradve only-must be confirmed) <br /> CVCHECK BOX TO EXPEDITE REQUEST-8$,105 FEE ICA H OR CHECK ONLY)-R QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �/% DATE <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS H USE ONLY <br /> Strout x � / Street Name CIh .„ _ Un It 1 <br /> J—S <br /> 2 nit2 <br /> 3. nit3 <br /> 4. <br /> 5. -- — --- -- - - n4 U " <br /> 6. <br /> - - — -- — <br /> 7. units <br /> 8' <br /> g, ❑ unite <br /> 1O. <br /> Specific Data Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES (� <br /> UNDERGROUND TANK(USTI CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FA( /I <br /> ❑ FOODFACILITY CI WASTE TIRE II p�l1� � \ <br /> �QQQTHER CLEANUP SITE(NONLOP) I n/ <br /> H""ERGROUNDTANK(MONITORINWREMOVAL)P>'` 11 DOG KENNEL 0_DA y <br /> AZARDOUS WASTE GENERATOR.�( <br /> C3 CHICKEN RANCH Id WASTEWATER TREATMENT PLANT <br /> ❑TIEREDARDOU WASTITTED GENE Y V� I7 MOTELIHOTEL In PUMPER TRUCKIYARDICHEM TOILETS <br /> •TAT7001BODY PIERCING O POOL/SPA �1 T❑LAND USE APPLICgA711SITES <br /> ❑MEDICAL W ASTE FACILITY OTHER(PLEASE SPECIFY) r,-d/IG 7W M 4-.5 ON <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRID Y 8:00 AM-6:00PM - EXCLUDING HOLIDAY$. <br /> 1. List up to ten addresses In the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(es). At least one Tile type MUST be selected. Fax to(2091 484 0138 or mail to the address Indicated above Address <br /> file addresses,contact the EHD. Appllcabons received after <br /> ranges will not be accepted-for additional assistance with <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 ton(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 filo is available. <br /> 4. Any filo not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future fila reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> PUBLIC RECORDS RELEASE 'FORM <br /> EHD 4M6 8/04/08 <br />