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JUN-14-2010 MON 04;56 PM FAX NO. P. 01 <br /> —- ,%Nov � <br /> DD _ £HD LOG NUMBER, <br /> 11 :- ,SAN'`jb-AQUIN f'0UNTY <br /> j'UN 1 4 Lu"" ENVIRONMENTAL HEALTH DEPARTMF_NT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVI+`���s�MI,p i, i HE one;(209)468-3420 Fax: (;?09)464-0138 Web:www.sjgov.org/eh <br /> PE;;�,AHj <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: K4f BUSINESS/AGENCY:1)Mr er ffd�te -'Re, 1 LLC <br /> ADDRESS: 50 f t'GMan•} $� . 2O }=_I _ _' CITY/STATE/ZIP; 4n Pro t C 10 S <br /> PHONE(1):k5) 591 ---7572 ...PHONE (2):_&is)sg j_-750Q FACSIMILE: 91—-7510 <br /> TENTATIVE*APPOINTMENT DATE: _ Time: <br /> (Please allow 10 business days from dotu of apphcatlen Submittal-"Tentadya.only-must ba confirmed) <br /> O'CHECK BOX TO EXPFOITE T $115 FSE:(CASFI OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT'REQUEDATE 4—/y--10 <br /> Electronic Information, ❑ List❑ Map—Description: <br /> FILE ADDRESS _ EHP USE ONLY <br /> StreSt Street Name city _MEl Unit 1 <br /> 2. - – — - ----- --- oft 2 <br /> 4 nit 3 <br /> 6. t _. _. nit 4 <br /> ❑Unit 6 <br /> 9. _ <br /> 10. ❑Unit 6 <br /> Specific Date Range.of Information Requostod: From to _f^I,�e 4 <br /> ENVIRONMENTAL HEALTH DEPAR�ILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP), [I HOUSING ABATEMENT ❑SOLID WASTE:FACILITYNEiHICLE <br /> ZOTHER CLEANUP SITE(NON•LOP) C.I FOOD F ACILITI C�WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) [I DOG KI,NNEL Q DAIRY <br /> HAZARDOUS WASTE GENERATOR [I CHICK.EiN RANCH ❑WASTEWATERTRI=ATMENI'PLANT <br /> ❑TIERED PERMITTED FACILITY [,�MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOIBODY PIE=RCING [I POOLISPA ❑LAND USE APPLICATION SITES , <br /> ❑ MEDICAL WASTE FACILITY I OTHER(PLEASE SPECIFY) A I5 0 aft Lac 11 Perm 1'f S and dr011Afern►4 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE:FOR REVIEW: MONDAY-FRIDAY B:DQ AM-S:OOPM(FxCLUDING HOLioA1✓b� <br /> 1,.List up to ten addresses in the space above. S016Ct the iype(s)of files from the list'above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Ealct(2691464-0136 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assislance 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 ajxist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held fora maximum of five business days for.review. Appointments <br /> should be scheduled accordingly. <br /> Mable for review. Anew application maybe <br /> 3. A file that is actively being worked on by END stat E ben t :- -;; <br /> submitted when the file is available. <br /> 4. Any file not returned In the same condition as rel<;ased will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a 6116 deposit prior to review. <br /> 5. If you need further assistance,please contact Qhtne Martinez,at(209)46.8-3425. <br /> 110 USE ONLY <br /> - 5/27108 <br /> ENP 4"fi <br />