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Ju1 : 30• 2008 10 : 89AM Adtaarced GeoEnvIronmental No . 2782 P . 1 <br /> DATE RECEIVED / 'l EHD LOG NUMBER <br /> SANJOAQUIN COUNTY <br /> ' l J/ ' Ii I <br /> DNVTRON114ENTAL HEALTH DEPARTMENT � q <br /> 600 East Main Street, Stockton, CA. 95202-2708 <br /> Telephone: (209) 46R-3420I ax ; (209) 464-0138 W b : www.sjgov.org/ch <br /> 7 <br /> E I i V ILL ' AU, PUBLIC RECORDS RELEASE APPLICATION ((( <br /> r n c ;ILS <br /> f APPLICANT IT M F, 114A BUSINESS/AGENCY: A , Cry , " <br /> ADDRESS: IS 3 7 S N q vJ' Ail <br /> PHONE: (1): �Z G4 y �f 7 — 1 O 1 PHONE (2)C ZQw 1 LVI FACSIMILE: <br /> TENTATIVE` APPOINTMENT DATE: JJAA Time: ABY 4, ; •A1 C <br /> (Please allow 10 buslness days from date of application submittal - 'Tentative only - must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE <br /> -RRE7QUEST - $,988-00 FEE (CASH OR CHECK ONLY) • REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 51(3NATURE OF APPLICANT l , <br /> /rgM , o DATE S <br /> Electronic Information : ❑ List ❑ Map — Description : <br /> FILE ADDRESS _. .._- EHD USE LY <br /> Street # _ Streee Name _ Ci_ty _ ❑ Unit1 <br /> 1' �.L- _ .. .KDd1t3At) STo 7c / ._ 5 <br /> 2 _ x ❑ Unit <br /> 4. _.. ..__ ❑ Unit <br /> 5. l <br /> s. llnK4 <br /> 0 <br /> 7. <br /> --- - - ---_ -_-_. ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to r7-�U cu9 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> •XUNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING A9AYEMENT 13 SOLID WASTE FAriLITY/VEHICLE <br /> D OTHER CLEANUP SIYE (NON-LOP) ❑ FOOD FACILITY G WASTE TIRE <br /> UNDERGROUND TANK (MONITORING/REMOVAL,) El DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR M CmciKEN RANCn rT WASTEWATER TREATMENT PLANT <br /> ❑ TIhRED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑ POOL/SPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY),_ _ - <br /> WELLANDSEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FRIDAYB:OO AM-5:00PM - EXCLUDING HOLIDAYS <br /> 1 . List up to ten addresses in the spare 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 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 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $98.00 deposit prior to review. <br /> EHD USE ONLY - <br /> "** If you should need further assistance please contact Diane Martinez Cw (209)468-3425 directly- Thank You" <br />