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08/19/2010 08: 34 FAX 9168529Geocon Consultants Z001/001 <br /> DATE R EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> . ENVIRONMENTAL HEALTH DEPARTMENT <br /> h1A 600 East Main St_ Stockton, CA 95202-3029 <br /> p�J " . �CSephdn3r(209) 468-3420 Fax; (209) 464-0138 Web; www,sjgov.org/ hd 71A <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> �C pp <br /> APPLICANT: Rowis.l BUSINESSIAGENCY:_COEL­3CADt-1 C�►,1��7t_,.�►_,-rj <br /> ADDRESS: ,((e C�DL-J 5 tJ�,'� jL_)R CITY/STATE2IP: O Cv2p4t ,[�Q _{5,Lgl <br /> PHONE (1):(N1) SS7-—9 1 ( S PHONE(2):(4-0_�-) FACSIMILE:(% <br /> TENTATIVE*APPOINTMENT DATE; —2,1.(CI Time: I ;o <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FE;I_(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG ATURE OF APPLICANT ( DATE IR,J(9— (c'-`) <br /> Electronic Information: ❑ List❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name City 'Unit 1 <br /> o I " S'�oc�ki No <br /> 2. <br /> nit 2 <br /> tm'/�/ U <br /> V I I ,; <br /> 4. Z7O <br /> A0. en'..-A nit 3 <br /> 6, <br /> nit 4 <br /> 7: <br /> e. <br /> Unit <br /> 9. <br /> 1 aw <br /> 6 l°1 <br /> S eclf{e DB4=Ring fha Requested: From to of ENVIRONMENTAL HEALTH DEPARTMENT FILES / <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT LRSOLID WASTE FACT ���� <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIREAt <br /> IUNDERGROUND TANK(MONITORING/REMOVAL)0� ❑DOG KENNEL DAIRY 4 „ <br /> HAZARDOUS WASTE GENERATOR a ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT x <br /> TIERED PERMITTED FACILITYV� ❑MOTEUHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATToo/BoDy PIERCING ❑POOL/SPA �LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEAS!:SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(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(2091464-0136 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 flies 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 EMD 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 EMD staff at that the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review, <br /> ^ <br /> r <br /> lND list;ONLY <br /> n a <br /> l <br /> �— z�2 )=(a f)'2 dk 14 <br /> AHD 4 ue <br /> e�nen <br />