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11/30/2009 13: 52 5099284415 UPS PAGE 01/61 <br /> FDg �"S II JJ SAN JOAOUIN COUNTY END LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 3 0 2009 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P MITISFR IGES <br /> APPLICANT: S 1 - �} Q 1Crl �4�ti } �USINESS AGENCY:_ UPS <br /> ADDRESS: /✓, r7 L� S CITYISTATEIZIP: ICL�L wi4 O/ <br /> PHON 1}: jag yy1 �j PHONE(2):^ `j `�V y-38o_q FACSIMILE: ,$ 9— aa2l <br /> r TENTATIVE'APPOINTMENT DATE: Time: <br /> 'J (Pfease allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> Cr CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> (t�N' SIGNNA\\\TURE OF APPLICANT DATE <br /> Electronic Information: ❑List ❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name CRY Unit 1 <br /> 1.� _55oZ _. 1 N, <br /> �r✓J <br /> I z 657/(-/ G IG� S+0C.C'1 Q'— Unit 2 <br /> 13. <br /> 4. Un 3 <br /> $ _ Unit 5 <br /> 9. _ <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From g'o to Pj24t4AJ, <br /> f <br /> ENVIRONMEN L HEALTH DEPARTMENT FILES v <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) U. OUSING ABATEMENTOLID WASTE FACILITYIVEHICL'9 I ,�Qj <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE I{. � tG% <br /> UNDERGROUND TANK(MONITORINGMEMOVAL)X ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATORO` ❑CHICKEN RANCH &?WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALToll. S <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. Llst ua to ten ad-dresses in the space above. Select the types) of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax (209)464 0138 or mail to t e address,IMIca#ad 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 fila 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 /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425y <br /> END USE ONLY <br /> EHD 40-06 8/Z7l09 <br />