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03/08/1010 MON 12!59 PAX 20*433 Bac ERD � 2002/002 <br /> [RECT "ONED SAN JOAQUIN COUNTY END LOG NUMBER <br /> -AAR 0 9 010 ENVIRONMENTAL HEALTH DEPARTMENT ��' ?3600 East Main St.Stockton,CA 3029 o <br /> ENVIRONf�1tNT HEAL�pnone;(209)468-3420 Fax:(209)484-01388 Web:Web:www,SJgov.Org/ehd <br /> PER VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:__ �1�21g�'nf7(r1t2U2 V7- _,-, 88U5INESS/AGENCY: <br /> ADDRESS: %S t= - lMn..\ k% �(CS CITY/STATEIZIP:_ <br /> PH0NE(1): q Ei( -!F$Sj( PHONE(2): FACSIMILE: k64-Kgs <br /> TENTATIVE'APPOINTMENT DAiE: Time. <br /> (Please allow 10 business days from dam of applioation submittal- r nfatlVa only-must be cardlrmed) <br /> ;HECK BOX TO EXPEDITE R -5115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3- �h <br /> Electronic Information: ❑List Jj Map-Description S�— <br /> FILE ADDRESS fill USE ONLY <br /> Street# Street Name City _ Unit1_ <br /> 2. 50 - <br /> unaz <br /> 3 <br /> 4 n <br /> 5 nes / \ <br /> 6. \ <br /> T Una a <br /> 8. <br /> Units <br /> 8. <br /> 10. <br /> Quarto <br /> Spsdfio Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSINGABATEMfNT ❑SOLID WASTE FACILITYNENICLE <br /> ®OTHER CLEANUPSITE(NON-LOP) D FOOD FACILITY ❑WASTE TIRE <br /> ISJ UNDERGROUND TANK(MONITORINGIREMDVAQ ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑-�WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL 0PUMPERTRUCK/YARDICHEMICAL TOILETS <br /> ❑TATrooftny PIERCING ❑POOUSPA ❑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-5:00PM(EXCLUOIj,1 HOLIDAYS) <br /> 1. List HIS to ten addresses In the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(es). At leastone file type MUST be selected, .19 091464-0138 or mail to the address Indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,Contact the FIND. 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 wii(behold 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 avaliable for review, A new application maybe <br /> submitted when the file ie available. <br /> 4. Any file not returned in the sane 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$115 deposit prior to review. <br /> 5. of you need further assistance,please contact Diane Martinez,at(209)468.3425. <br /> sHousE oaLv <br /> erfDaeoe <br /> BN7109 <br /> TO 39Vd A3-13 H3HdOlSI21H0 017E999b60Z TS:TT 0TOZ/60/£0 <br />