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From:Marcus H. Bole & Associr,.,,s 530+633+0119 <br /> 1210,..e09 16:12 #140 P.001 <br /> EHD LOG NUMBER <br /> SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> L.k, 0 7 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONMtNT HEAJklephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.o <br /> q0 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION 4 <br /> APPLICANT: v /h BUSINESS//AGElNCY:I/('%(+&r�Zr' <br /> ADDRESS: 1�2 y br0 c% City/State/Zip <br /> PHONE(1): �.�✓—G3� n�� 7 _ PHONE(2):�30- 4�o� FACSIMILE: �i 5'n "��'3" // <br /> TENTATIVE'APPOINTMENT DATE: � �/7 /ham"S Time: 9U <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ���1����—�-{�� DATE <br /> Electronic Information: ❑List E] Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. Ljj C/ ✓�/7,_ �? ( 0 �� til [] Unit 2 �� <br /> 3. ��a 7� <br /> 13 <br /> 4. <br /> p <br /> 5. 0 _ u c' � __ L 75-1 ❑ Unit 4 <br /> 7. <br /> 9. D Unit 6 <br /> 10. <br /> Specific Date Range of information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ZkDERGROUND TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT MIS-OLIDWASTEFACILITYNEHICLE <br /> j OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY a WASTE TIRE <br /> Q-tT ERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL DAIRY <br /> AZARDOUS WASTE GENERATOR 17 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 0 MOTEUHOTEL E3 PUMPER TRUCKNARDICHEM TOILETS <br /> O TATTOO/BODY PIERCING 0 POOL/SPA 13 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - 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)464-0138 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. 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 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 /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />