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FrowMarcus H. Bole & Associ,,,.,,� 530+633+0119 12/0..0J09 16: 12 #140 P.001 <br /> U [F� <br /> DEHD LOG NUMBER <br /> SAN .1OAQUIN COUNTY <br /> 0 7 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONWIT HEALTNe lephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.o <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION �+ <br /> APPLICANT: nnl-` BUSINESS/AGENCY:/ <br /> USINESS//AGENCY: I la1�✓i ��1���r' ,CS c)� <br /> ADDRESS: 16 ?�roCA- !//"/✓� CitylState/Zip L/�/iP,1l7/�li'l <br /> PHONE(1): _�c�✓ �3� ")//iz PHONE(2):,S:-�C —cZIT— (oto l FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: �,� Z T17,• Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT '` �i�-�1��, 5 � O DATE <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street ft Street Name City ❑ Unit 1 <br /> 2. EoZ !x Ort /� e !" ❑ Unit 2 <br /> 3. 7/- <br /> 4. <br /> G4. � . c` �� t 3 \'l/ <br /> 7. Z2"1-),/ _ 4�n <br /> L10. <br /> IV— C� // Unit 6 <br /> 9 /b, C/,-r - lj I // <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> PT UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT e SOLID WASTE FACILITY/VEHICLE <br /> C 'OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 WASTE TIRE <br /> 1�3�N ERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> tg,-# AZAZARDOUS WASTE GENERATOR 10 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> C]TIERED PERMITTED FACILITY ❑MOTEUHOTEL 13 PUMPER TRUCKNARDICHEM TOILETS <br /> O TATTOO/BODY PIERCING 0 POOL/SPA 13 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 17 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-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)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 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 END 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 /> FHn AR-ns 11104/08 PUBLIC RECORDS RELEASE APP FORM <br />