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08/12/2009 08:23 9252741103 ARCADIS #0504 P. 002/003 <br /> n • <br /> (uL�{� �EDO SAN .10AQUIN COUNTY EHD LOG NUMBER <br /> AUG 12 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 114 <br /> 209)464-0138 Web: <br /> ENpERM�TIcERVICES Ileph 5� 77 ,3 <br /> PUBLIC RECORDS(RELEASE APPLICATION <br /> rslend <br /> APPLICANT: Lf-lak Nvanj BUSINESSIAGENCY: lq-cP"t�1S <br /> ADDRESS: a{j3a, NorH•I Mcln Surra Cie 39U CITYISTATElLIP: WQ]nut CYYekr gy,96 <br /> PHONE(1): ��/Q�9(p5�Sa1/ PHONE(2) FACSIMILE: <br /> TENTATIVE'APPOINTMENTDATE: �I �aC� Time: /O:Dd AM <br /> (Please allow 10 business days from date of applicadon submlaal.'Tentadye only.must becon"'= <br /> 10 CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU S <br /> . <br /> SIGNATURE OF APPLICANT DATE <br /> h, <br /> Electronic Information: ❑ List[ Map—Description: RAQ flYo d AT ckAgae <br /> FILE ADDRESS EHD USE ONLY <br /> Street R BblaefName city ❑Unief <br /> 1. BIB W. Fr _e•�,., 57" -mrti ad <br /> u r .I- ,Aar,et's/a <br /> 2• 345 n(, asrf rr Srrzr 5 oc rc. D - nit <br /> 3. joji6 EMexv S ro r-K- <br /> 6 a 3o In Sro �. . • <br /> s hz f r sh,c <br /> s STV c4rz�f <br /> 7. <br /> t4 <br /> s. bk7 (_ . .N V. S T:o ❑Unit$ <br /> 9• . ST-0u1' ?It U - <br /> 10. b /v• 1 �()S� DI IY N0 l7 nits <br /> Specific Date Range of Information Requested: From ISSD to A L <br /> 1UNDERGRovND <br /> ENVIRpNMENTAL HEALTH DEPARTMENT FILESUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HWSINGABATEMENT �$OUO WASTE FAGLIiYNEHI L'EE n,; $ IPGj k/ <br /> OTHER CLEANUP SITE(NowLOP) re ❑FooD FACILITY _ ASTETIREe 'AA1� ?�TANK(MONDORINGIREMOVAL)�/• ❑DOGle7I. ❑DAIRY W'X/nn <br /> ®HAZARDOUS WASTE GENERATOR o(, ❑CHI Z[WASTEWATER TREATMENT PLANT 1 `t^� <br /> ®TIERED PERMITTED FACILrTYQ( :1 OT L f3PUMPERTRUCKIYMDICHEMICALT01 +F`y,, <br /> ❑TATTOOIBODY PIERCING :)P O A pl LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTI 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 type MUST be selected. Fax to(209)4640138 or mail 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 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. Afile 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 reorgan¢ed by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$115.00 deposit prior to review. <br /> EHU USE ONLY <br /> 'If you need further a$SI$tance please contact Diane Martinez @ (209)46$-3425 directly. Thank Yol <br /> ( Dq' CoM 31 <br /> eNo <br /> ]l11/e009 <br />