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03/07/2011 MON 9: 33 FAX 2094682999 SJC Public works 0001/OD1 <br /> ReMVEIP11% <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> fi'AR 0 7 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Lust Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> E�iVlRpt+�MrAL <br /> PERi~,�IT/SERVICES QTR <br /> // PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. 1810 <br /> 1 fC BUSINESSIAGENCY: 5,1�.� <br /> ADDRESS: ! J E. <br /> e Cittyy/Staterzip S O Sr <br /> PHONE(1): hLJ L3©ppPHONE{2): _ ^yGG �DDC7 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> .(Please allow 10 business days from date or application submittal-'Tentative only-must be confirmed] <br /> ❑ CHF-CK BOX TO EXPEDITE RE 'B5T- 105 F CA5 OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3ZM1 <br /> h Electronic Information. ❑List❑Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# C / Street Name/ j city /}—Cj5:2�' <br /> Unit <br /> '5100 C GA ids GAG[ �QJ� �0.fW�1Q� S���ixO� � <br /> 2, • d tt Unit 2 <br /> 3. 66 ll <br /> 4. ll It <br /> �-^ Unita <br /> LSCA. � <br /> 5. �00 Untt 4 <br /> 7. t0fa g' C, as — <br /> Unit 5 <br /> 8. 11000 <br /> 9' lZr Unit s <br /> 10 1 3 Z �1 Si4-9f�'3i <br /> Specific Date Range of information Requested:From t <br /> ENVIRONMENTAL_HEALTH DEPARTMENT FILES <br /> I y��, <br /> - UNDERGROUND TANK(UST)CLEANUP SITE(LOP) �fOVSING ABATEMENT SOLID WASTE FACILITYIVEHICLE - <br /> )1FbTHER CLEANUP SITE(NON-LOP) )MFOOD FACILITY 13 WASTE TIRE <br /> _UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL -DAIRY <br /> } AZARDOVS WASTE,GENERATOR CHICKEN RANCH )ErWASTEWATER TREATMENT PLANT <br /> 17 TIERED PERMFTTED FACILITY E3 MOTELIHOTEL )PUMPERTRUCKIYARDICHEM TOILETS <br /> L7 TATTOOIBODY PIERCING 13 POOLISPA IIMLAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> " WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVEEW-MONDAY-FRIDAY 8:00 AM-5:00PM -EXCLUDING HOLIDAYS. <br /> E 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(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 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 Wavailable, . <br /> 4. Any file not returned in the same condition as released will be reorganized by EH15 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 /> r <br /> i END 40-06 8104108 PUBLIC RECORDS RELEASE APP FORM . <br />