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04/28/2009 11:06 SIERRA..DELTA CONSULTANTS LLC 4 12094640138 NO.961 901 <br /> � v III <br /> EHU LOG NUMBER <br /> D SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR 2 S 2009 304 East Weber Avenue, 3i1 Floor, Stockton,CA 95202-270 <br /> ZI <br /> 1wIRONMENT HEALTHTVIophenc:(209)46R-3420 Fax:(209)464-0138 Web:TwT'w.sjg0v.org hd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> -r (r BUSIN01IIAGENGY: <br /> APPLICANT: _ n <br /> ADDRE33 r�, Tl Gy�t 171 `f�.,ari- c�� 7.�7 <br /> PHONE(1): 1(Ll2 e�3 !-K � PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow TO business deys from dam cf epPllc4tion submRtal-'rontadve only-must be confirmed) <br /> El CHECK 60X TO EXPEDITE REQUEST•S05.00 FEE A H GH ONLY)-REQUEST PROCESSED IN 7 USINESS DAYS <br /> SIGNATURE OF APPLICANT C�Uu DATE � G1 b ZA1 <br /> UNIT OISTRIBUTK)N 0Umt1 0Unit 2 GUnit 9 13Unit4 ❑Unit 5 0 Unit6 O other(alectronlclllstalmaPA) <br /> FILE ADDRESS EHD USE ONLY <br /> Street tl Street Name _ TClty <br /> 1 <br /> 2.3. <br /> \�Q <br /> 4. <br /> S. -- -- <br /> 6. <br /> 8. <br /> 9. <br /> \J <br /> 1 B. <br /> V Specific Clete Range of intormation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOEROROUNG TANK(USTI CLEANUP SITE(LOP) O HOUSING ABATEMENT Cl SOLID WASTE FACILITYIYEHICLE <br /> 0 D HER CLEANUP SITZ(NON4-OP) 0 FOOD FACIUTT ❑WASTE TIRE <br /> �.�UNDERGROUND TANK(MONITOKINOIREMOVAL) P DOG KENNEL ❑DAIRY <br /> O HATARDOUS WASTE GENERATOR 13 CHICKEN RANCH O WASTEWATERTREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOTELIHOTEL O PUMPtRTRUCRITARDICNEMTOILFTS <br /> n TATTOOMODY PIERCING 0POOUSPA O LAND USE APPLICATION SITES <br /> •MEDICAL WASTE FACILITY O OTHER(PLEASE SPECFY) <br /> WELL AND SEPTIC PERMII'RECORDS ARE AVAILABLE FOR Review - MONDAY-FRIDAY 9:00 AM-5:00PM - EXCLUDING H01lOAYS- <br /> 1. List up to ten addresses In the space above. Select the type($)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2081 464.0138 or mail to the address <br /> indicated&gve_ Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled aoeordingly, <br /> 3. Afile that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will bo reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same appticant may require a$83.00 deposit prior to review. <br /> rND u axau <br /> tnaar <br />