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MAY-28-2009 15:15 TO Tech, Inc. 415 974 5914 P.02 <br /> i <br /> DATE RECEIVED EMD LOG NUMBER <br /> SAN.l()AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton, CA 95202-30294352 <br /> Telephone:(209)468- 0 Fax: (209)464-0138 Web:www.sjgov.oPUBLI CORD RELEASE APPLICATIONy <br /> 7APPUCANTi -Yylill A C4 O.Y'L U BUSINESSIAGENGY- JekY(4 �Tedo <br /> SS: ISD c�GJi' C `5C cltylSkataf2lp vFY0.t11(ASGC GR '14j0 <br /> PHONE(1): '41'5 C5'6i 02--Lqo PHONE(2): V51114 kZ7_1 11nam1._FACSIMILE; 5914 <br /> TENTATIVE'APPOINTMENT DATE <br /> (Please allow 10 business days from data of appllcatlan submktal -Tantanve only-must be eonnmled) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST ORCHECK ONLY)-REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE , E5 2.B 109 <br /> Electronic Information: ❑List❑Map-Description: <br /> ..—.vFILE ADDRESS .. . _ .._-_--- EHD USE ONLY _--____--- <br /> SVMta — —Street Name _ _ I <br /> city - Unlet <br /> -041 <br /> 2 Unit2 <br /> 3. <br /> �....._-_ -- I umea <br /> l5• � Unk4 <br /> _-..- --�... --,_.,.,..._.�- -•...--- ❑ Units <br /> 9. unite <br /> Specific Date Range of Information Requested:From I cl OG to ...��125 r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(USI)CLEANUP SITE(LOP) 0 NOOSING ABATEMENT 9 SOW WASTE FACiLMNEHICLE <br /> X OTHER CLEANUP SITE(WON-LOP) ❑FOOD FACILITY IS.WASTETIRE <br /> 0 UNDeRGRODNo TANK(MONrfOHINGIRENOVAL) C3 Doe KENNEL 13DAIRY <br /> .1K HATpRDOW WASTE GENERATOR L)CHICKEN RANCH AWASTEwATERTREATMENTPLANT <br /> X TIERED PERMITTED FACiuw E3MOTELIHOTEL 0 PuNPERTRUCK(YARDICHEKTOILETS <br /> ❑TATTOOIBOOY PIERCING In POCUSPA at LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY p OTHER(PLEASE SPECIFY) <br /> WELL ANDSEPne PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FMOAY 9:00 AM-S:ODPM -ExcL NO HOUMYS. <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 sslecled Fax to 1209)4640138 or mail to the address indicated above-_ Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications reCeiv KI after <br /> 3:00 pm will W 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 atter 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 avallable. <br /> 4. Any file not returned in the some 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$105 deposit Prior to review. <br /> EHD USE ONLY <br /> EHD 4846 5@4= PUBLIC RECORDS RELEASE PPP FORM <br /> TOTAL P.02 <br />