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HOU-22-2009 15:23 ARCADIS BRIGHTON MI 810 229 8837 P.02i02 <br /> � �� EMD LOG NUMBER <br /> M,E JI�I�) SAN .JOAQUIN COUNTY' <br /> �__I ,_r <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N '9 j Z'009 600 East Main St. Stockton, CA 95202-3029 <br /> TP1 hone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or / <br /> EI���II�(.)lVI`v!tiV I i��Al_I(�p www.sjgov.org/LtQ <br /> i411T LN, 1-i�PA PUBLIC RECORDS RELEASE APPLICATION <br /> ��IRI IIII I IIIA'® <br /> APPLICANT: �►�IMA� l BUSINESS/AGENCY: cae- Cr1V1r0V)01ef <j <br /> ADDRESS: lj!jSq �',� {l�� D(, �L-L;jtjoa CITYISTATE/ZIP: f" kfon $ <br /> PHONE(1): X10 --Z2, �1�jSh PHONE(2): ----rr' FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Jd1,'jf wed 46&S - Carl f torn4_ Time: <br /> (please allow 10 business days from date of application su mittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: (] List❑ Map-Description: <br /> _ FILE ADDRESS END USE ONLY <br /> Street# - ^ Street Name City Unit 1 <br /> 1. Z Z Son �c vL _..___...._._ _ (Y') <br /> 2. ❑unit z <br /> 4. <br /> nit 3 <br /> r6. <br /> Unit 4 <br /> 7. <br /> units <br /> 9. - <br /> 10. <br /> /Unit 6 <br /> Speclflc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FAGLITY WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILrrY Q OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Rhy1EW: MONDAY-FRIDAY$:00 AM-5:00m(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 END 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 now 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$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)488-3425. <br /> END USE ONLY <br /> END 48-08 <br /> er�iroa <br /> TOTAL P.02 <br />