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u <br /> n� From : Mararccugs H . Bole & Associ 530 +633+ 0119 1210 1.09 16 : 12 # 140 P . 001 <br /> Ifl] � IIJ C� E 1 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ii ' � 0 7 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> T w600 East Main Street, Stockton , CA 95202-3029 <br /> ENVIRONMtNT HEALTITFlephone: (209) 468-3420 Fax: (209) 464-0138 Web: ww .sjgov.o <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION G <br /> APPLICANT: � v ��T '_ BUSINESSIAGErNCY: C/R.: ✓ ( ��i7c'�/y �-LSAr <br /> ADDRESS: �� / �Y'OC/r //,I�/ J City/Stateizip <br /> PHONE ( <br /> PHONE (2): �-30 _y/S�C �v_,� '� L�r� Id FACSIMILE: `),SAO -(x-. 2 - - C> / / 7 <br /> TENTATIVE" APPOINTMENT DATE: �3 7 11;u;-.S Time: 9 3C7 <br /> (Please allow 70 business days from da a of application submittal - 'Tentative only - must be confirmed( <br /> CHECK BOX TO EXPEDITE REQUEST - $105 FEE <br /> (C(CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT f/ DATE �7/0 <br /> Electronic Information: ❑ List ❑ Map - Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name City ❑ Unit 1 <br /> 1 . ( �� v✓7Lii �r r o uC� r r,r <br /> 24 <br /> /' 1 El Unit 2 <br /> 13 <br /> 4. Ztel �SuW <br /> 5. ! � S a 7 41, ❑ nits <br /> 8. a 0Mr <br /> 'ziRli 6P4 '3 Units <br /> 10. p —T k/ C <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 5 UUNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT la SOuo WASTE FACILITY/VEHICLE <br /> 4A OTHER CLEANUP SITE (NON-LOP) 0 FOOD FACILITY M WASTE TIRE <br /> q-uN ERGROUND TANK (MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> IFAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELWOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOLSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AN-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) 4644138 or mall 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 48A6 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />