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04/27/2009 16:16 FAX 916 817 4747 H D R ENGINEERING 2001 <br /> II�ED . • EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> APR 2 7 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> NT HEAtTF� (600 East Main Street, Stockton, CA 95202-3029 <br /> ENPE ON LN1 HEE e ephone: 209 468-3420 Fax: (209) 464-0138 Web: www.sjgoqz 7 <br /> PUBLIC RECORDS RELEASE APPLICATIONS <br /> APPLICA ' : 5� +� �N-' BUSINESS/AGENCY: t'ti�T <br /> ADDRESS 2.3.0 5 IFLOIV ELDi+�'r>' � ��_ <br /> , I city/statelzip � t_.,S0 M, f=%4- 3O <br /> PHONE(1r �tl "a �' ' PHONE(2): FACSIMILE: Cti to-8 t�I•�'� <br /> TENTATIVE'APPOINTMENT DATE: '518 / yci _ Time: <br /> (Please allow 10 business days from date of apolication submittal--Tentative only•must be confirmed) <br /> d CHECK BOX TO EXPEDITE REQUEST-$1,05�,FEE <br /> -.(CASH <br /> �OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATPRE OF APPLICANT DATE 4_27 kq <br /> Electro Ic Information: ❑ List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> treat# StCity Unit 1 <br /> A/ 73 ,�U�N,me <br /> nY o^� 6E a <br /> 5 o�11T�a U Z'/AI6, yUnf2-r-o G�raJ$' Unita5. I SIsvGA�bIJ ,A SCD/j1 ... nL4 <br /> i Pelf N. °I�l sic ac1-o. t VIOL r <br /> 7. ❑ Unit 5 <br /> 8. <br /> 9, it ❑ Unitfi <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ��,_// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �NDER ROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> �..���yyy�O��.THER LEANUP SUE(NON-LOP) C1 FOOD FACILITY 0 WASTE TIRE <br /> NDERGRODND TANK(MONUORINGIREMOVAL) �DOG KENNEL 0 DAIRY <br /> ❑HAZAR Gus WASTE GENERATOR 0 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED ERNnTED FACILITY 13 MOTELIHUrEL ❑PUMPER TRUCKIYARO/CHEM TOILETS <br /> 0 TATTOC tBOOY PIERCING O POOL/SPA 0 LAND USE APPLICATION SITES <br /> O MEDICI L WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> q WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY•FRIDAY 8-00 AM-5:00PM - EXCLUDING HOLIDAYS- <br /> 1. List I p to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> hox( s). At least one file type MUST be selected. Fax to(209)'464.0138 or mail to the address indicated above. Address <br /> rangi s will not be accepted—for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 im will be processed the next business day. <br /> 2. The I HD 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 /> shoa�d be scheduled accordingly. <br /> 3. A fil that is actively being worked on by EHD staff may not be immediately available far review. A new application may be <br /> sub Itted 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 /> Fatale Nle reviews by the same applicant may require a$105 deposit prior to review. <br /> ry EHD USE ONLY <br /> '9 - <br /> y r. <br /> , <br /> EHD 46•D, 8/04/0 PUBLIC RECORDS RELEASE APP FORM <br />