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Apr 23 10 09: 47a Krazan & Associates 55934840 r. 1 <br /> ��'�/•�y"'EBOD <br /> SAN .JOAQUIN COUNTY EHD LOG NUMBER <br /> 2 3 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> T�E�l 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIE ML T BEAU Hrelephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mgl._ PZP'ZnlwJ BUSINESS/AGENCY: <br /> ADDRESS: 21S W- MK-&TAA 4V,_� City/Statefzip C _p--';.S . CA r(1•�. <br /> PHONE(1): 559. 4+ '. 0006 PHONE(2): FACSIMILE: .SS9• .''a TS <br /> TENTATIVE'APPOINTMENT DATE: Paprp Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ill AC5(1 U <br /> ctl 11Z, <br /> Electronic Information: ❑List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 1. L LATH CQ z` t - ❑ Unit1 <br /> 2. L - -I S- <-� nit <br /> 3. <br /> 4, n a <br /> 5. <br /> 6. 4III,,giiiiiUnit 4 <br /> 7. <br /> 8 El unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested:From pr-vu to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �tJNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY R`WASTETIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH %WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> 13 TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:0OPM . EXCLUDING HOLIDAYS. <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 selected. Fax to(2091464-0138 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 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 fife 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4MG 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />