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Do SAN JOAQUIN COUN 3 0 2009 ENVIRONMENTAL, HEALTH DEPA 600 Est Main S. Stockton, CA 95202- ENVIRONMENT HEALTH Telephone: (209) 468-a3420 Fax: (209) 464-0138 Web: PERMIT/SERVICES NUMBER PUBLIC RECORDS RELEASE APPLICA ION APPLICANT: MATT SMALLEY ADDRESS: 724 VALI,E,JO WAY BUSINESS/AGENCY: DELTA PHONE (1): 916 446 3803 PHONE (2):CITY/STATE/7-IP: SACRAMENTO FACSIMILE: 916 638 6385 TENTAT/VE*APPOINTMENT (DATE: (Please allow 10 buslness days f Time: y fro date of application submittal •'Tenrarlve only • must be confirmed) ❑ CHECK BOX TO EXPEDITE REQUEST - $11�EE (C H OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT ®� DATE 12_—_k) -0q Electronic Information: [] Lipw�st ❑ Map — Description: �j 4. I 16470 5. 3978 6. 7. 8. 9. CAMBRIDGE DRIVE HWY 99 STH ^ n� LATHROP STOCKTON EHD USE ONLY Specific Date Range of Information Requested: From ALL ENVIRONMENTAL HEALTH DEPARTMENT FILES to PRESENT ` UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT I I� ❑ OTHER CLEANUP SITE (NON -LOP) ❑SOLID WASTE FACILITYNEHICLE ❑ FOOD FACILITY ❑ WASTE TIRE ® UNDERGROUND TANK (MONITORI NGIRE M OVAL) ❑ Dm KENNEL ❑ DAIRY ® HAZARDOUS WASTE GENERATOR,4 E] CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT ®TIERED PERMITTED FACILITY pl\ ❑ MOTEL/HOTEL ❑ TATTOO/BODY PIERCING[] PUMPER TRUCK/YARDICHEMICAL TOILETS ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses In the Space above. Select the types) Of files from the list above by checking the appropriate box(es). At least One Ale type MUST be selected. Fax to (209} 464 Q13S or mail to the address Indicated above Address ranges will not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant If any EHD files exist An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly, 3_ A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the Ale Is available. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. Future file reviews by the same applicant may require a $115 deposit prior to review. 6. If you need further assistance, please contact Diane Martinez, at (209) 4138-3426. FILE ADDRESS Street Name City F32 __ �;wy 99 NTHSTOCKTONFREMONT W STOCKTONCALIFORNIA ST STOCKTON �j 4. I 16470 5. 3978 6. 7. 8. 9. CAMBRIDGE DRIVE HWY 99 STH ^ n� LATHROP STOCKTON EHD USE ONLY Specific Date Range of Information Requested: From ALL ENVIRONMENTAL HEALTH DEPARTMENT FILES to PRESENT ` UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT I I� ❑ OTHER CLEANUP SITE (NON -LOP) ❑SOLID WASTE FACILITYNEHICLE ❑ FOOD FACILITY ❑ WASTE TIRE ® UNDERGROUND TANK (MONITORI NGIRE M OVAL) ❑ Dm KENNEL ❑ DAIRY ® HAZARDOUS WASTE GENERATOR,4 E] CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT ®TIERED PERMITTED FACILITY pl\ ❑ MOTEL/HOTEL ❑ TATTOO/BODY PIERCING[] PUMPER TRUCK/YARDICHEMICAL TOILETS ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses In the Space above. Select the types) Of files from the list above by checking the appropriate box(es). At least One Ale type MUST be selected. Fax to (209} 464 Q13S or mail to the address Indicated above Address ranges will not be accepted -for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant If any EHD files exist An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly, 3_ A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the Ale Is available. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. Future file reviews by the same applicant may require a $115 deposit prior to review. 6. If you need further assistance, please contact Diane Martinez, at (209) 4138-3426.