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04/24/2009 12:56 SIE '"1 DELTA CONSULTANTS LLC 4 1209464017' NU.955 D01 <br /> I <br /> EHO LOG NUMBER <br /> rIAT 9FC SAN.1 OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2 4 2009 304 East Weber Avenue, 3'l Floor, Stockton, CA 95202-270 <br /> Telephone:(209)468-3420 Fax:(209)464-0139 Web:www,sjgov.org/ <br /> ENVIR(MENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/LERVICER <br /> APPLICANT: BUSINE35lAGENCY: <br /> AD0RF3S: rG �` <br /> PHONE(1): <br /> EPS-- 2-S±• rPHONE(2)= FACSIMILE: a 0� <br /> TENTATIVE'APPOINTMENT PATE: Time: <br /> (Please allow 10 business days from date of application submlttal-'Te17tat1V0 only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST 00 FF ASH O HFCK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 01- <br /> SIGNATURE OF APPLICANT �S WZ DATE 4,24, <br /> UNIT DI$TRTION C1 Unit 1 A Unit 2 0 Unit 3 ❑Unit 4 E3 Unn 5 0 UnIt 0 ❑ Other <br /> I6U (olectronlclllatslmapt;) <br /> FILE ADDRESS HD USE ONLY <br /> Speot M Street Name_ GKY <br /> 1, tIS oVTA <br /> }rer~ k Y <br /> 2. 1 5 <br /> 3. <br /> 5. t , <br /> 7. <br /> B. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to /1/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q HOUSING ABATEMENT Cl SOLID WASTE FACILITYIVEHICLE <br /> i NDERdROUND TANK(UST)CLEANUP St7P_(LOP) 0 WASTE TIRE <br /> 1 THER CLEANUP SITE(NON-LOP) 1Q FOOD FACILITY <br /> E3 Doa KENNEL d DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL)GENERATOR <br /> RING/REMOVAL)a p CHICKEN RANCH t7 wASTEwATER TREATMENT PLANT <br /> 0 HAZARDOUS WAaTe GENERATOR n0 <br /> 0 MOTK1HOTFL 12 PUMPER TRUCKIYARD/CHEM TOILETS <br /> O TIERED PERmirmo FACILITY V� L7 LAND UsE APPLICATION SITES <br /> 0 TATTOWBODY PIERCING O POOLISPA <br /> I:MEDICAL WASTE FACILITY 17 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAII-ABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HouDAYS. <br /> I. List up to ten addresses in the space above, Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least one filo type MUST be selected. Fax to(2091464.4011 38 or mail to the address <br /> 1 in leafed above. Address ranges will not be accepted r for additional assistance with-me addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five busines$ <br /> days for review. Appointments 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 <br /> application may be submitted when the file i8 avallable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$83.00 deposit prior to review. <br /> �j <br /> fJID N-0Idos <br /> 11t4Ms <br />