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OG / 03 / 2008 09 .51 FAX 5302491654, _ CH21 HILL 0002/ 002 <br /> EMD LOG NUMBER <br /> i DATEAECENED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT �70 <br /> 600 East Main Street, Stockton , CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 4640138 Web: wwwsjgov.o /e <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Umn a A Gl )q BUSINESSIAGENCY: CH16 PIIII <br /> ADDRESS: 4525 AirORKtS Or lied' c f-r <br /> PHONE (1): 3 "2�'t' �" `t`~ PHONE (2): FACSIMILE: arjU ' 339 '3214 14 <br /> TENTATIVE* APPOINTMENT DATE: bllxly8 Time: 176J <br /> (Please allow ten business days from date of application Submittal - `Tmfatfm only - must be confirmed) <br /> CHECK 60X TO EXPEDITE REQUEST - $98.00 FE �(CASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT t/ ' DATE <br /> Electronic Information: ❑ List ❑ Map - Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street* Street Name city 0Unit 1 <br /> r <br /> 3Ht3D ,5. ElOornkP } � }an �/ 0 <br /> 343?. 5 ,- Doff' nitz <br /> e4 LI rs h Qorn i. .Zea ++ + � F Unit3 <br /> -- �+ S . EI _Dvcado <br /> 7 3l 5 ( bora4o <br /> $, 03z +. a ❑ Units <br /> g. az�ax <br /> fit, <br /> S4 D �g <br /> nit6 <br /> 10. 80 ( 1 P.at 4 AY.e- . / F <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,!(UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT SOLID WASTE FAGLTTYNEHICLE <br /> ��OmER CLEANUP SITE (NON-LOP) 0F6OD FACILnY EfWASTE 'RRE <br /> AINDERGROUND TANK (MONITORINGIREMOVAL) 13 DOG KENNEL 0 DAIRY <br /> V�( AZAROOUS WASTE GENERATOR 0CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> nEREO PERMITTED FACILITY ❑ MOTEUHOTEL 0 PUMPER TRVCK/YARD/CHEM TOILETS <br /> 0 TATTOOISODY PIERCING 0.JPOOLISPA LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY w6THER (PLFASE SPECIFY) b,O$ "gy IOAA } .C. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY•FRIDAY 8:00 AM-5:00PM - EXCLUDING HOUDAYS. <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 (east one file type MUST be selected. Fax to MOM 404.0138 or mail to the above address. Address ranges will <br /> not be accepted - for additional assistance with file addresses, contact the EHD- Applications received after 3:00 pm will <br /> 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 <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 the EHD staff may not be immediately available for review. A new application <br /> may be 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 /> FWD 4046 10/30/01 PUBLIC RECORDS RELEASE APP FORM <br />