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Fein 26 2010 11 : 56HM Consultants 4 01--�557601 p. 1 <br /> EHD LOGNUMBER <br /> Mt Lu JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 <br /> FEB 2 6 �010 604 East Main St. Stockton,CA 95202-2708 � <br /> TeMphtrrlc: (209)468-3424 Fax:(209)454-0138 Web: www.ajgov.o e A �m% <br /> ENVIRONMENT HEALTH <br /> EALTH <br /> PUBLIC RECORDS RELEASE APPLICATIONP R1I <br /> APP1-IGANT: V{g q S BUSI NES91AGENCY: T (fi I r� <br /> ADDRESS: O 5c�i, gSLon u �c. f{]/ Ct.TYISTATEIZIP 5� 'u C_A IS <br /> PHONE(1} �. PHONE(2): g Hao- ,AFACSIMR_E: �-lfli;-�G9 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Pieeas aliow i0 business days kom pats of application sub miiii, -'rentatiye only-must be eordlrmed) <br /> E3 CHECK BOX TO EXPEDITE$EQUEST-$1[0&00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN <br /> S SMINESS DAYS } <br /> SIGNATURE OF APPLICANT= - �� _DATE �1"�S C-," � � li <br /> i <br /> I lecuonlc Irtformatlon: ❑List 0 Map-Dworlptfon: <br /> FILE ADDRESS EHD USE ONLY <br /> 8troet# <br /> Street NOMA city ^r QA <br /> a \ <br /> All x J <br /> 2. ;t <br /> 3. � <br /> 5. - �.�/ ✓ Lints 4 <br /> f3. <br /> - -untL s <br /> 8. <br /> 9 �nri 8 <br /> 10. ' <br /> cr11 1 v1 <br /> specific Date lunge of Information Requested!From GL., to ; <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I <br /> M UNDERGf UNI)TANK(UST)CLEANUP SVF-(LOP) p HOUSING ASATEWNT 12 SOLID WASTE FACILMA EHICLE � <br /> M OTHER Ct EAKUP SITE(NON4AM D FOOD FACILITY 13 WASTE TIRE <br /> M UNDERGROUNDTANK(MONTORINGIR@ANAL) CI DOG KENNEL. Z3 DMRy <br /> m HAWDow WAsTg GENERATOR 11 CRCKEN RANCH gkWAeTEWATEnTRaTMEW PLANT <br /> Q TIERF�P'ERNTTED FAC1U'Y 0 MOTEUNOTEL 0 PUMPER TRLICIUYAROFCHEM TOILETS <br /> r]TATTOOIBODY PIERCING q POOLISPA R LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACiUTY Q OTHER(PLEASE SPIECSfy) <br /> WELL AND SEPTIC PERMrT REGOR08 ARE AVA'LAVLE FOR REVIEW-1AGNGAY-FM0AY91:00 Am- -'DDP1A - EXCLUENNO HOUDAYs- <br /> 1. fiat Ua to ten rem�In the space above. Select the type(!)of files from the list above by checking the appropriate <br /> ss <br /> box(es). At least om file type MUST be selected. Fax (20p148 &j38 cr MW1 �Indicated ate,_ Actd W <br /> ranges vrlll not be accepted-far addltional assistance with file addresses,contact the EHD.Applications reoeived after <br /> 3:00 pm will be processed the next business day, roximatel ten 10 <br /> 2. The EHD will notify the applicant If arty EHO 41102 eAst. An appointme�It for review will ba confirmed app oltltltl�Its ( ) <br /> days after receipt of application. The files will be held for a mwdmurn of five business days for review. App <br /> should be echedded accordingly. <br /> 3. A file that Is actively being worked an by E HO staff may not he Immedletely"able for review. Anew appllcatian may be <br /> aLin lilted when the file is aveilable. i <br /> d4. Any fife not rraturned In the same cmdMon as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file mytews by the some applicant may require a€105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ""''If heed firr'ther ossistrulce lease Zwdwt bion Akartinex IND (209)468-3425 f - Thank You"""' <br />