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01/25/2011 11:14 510238 544 EBI©AKLAND PAGE 01/01 <br /> EHD LOG NUMBER _ - <br /> R r"DP1,.j-CtVE D SAN JOAQUIN COUNTY <br /> Alv 2 ZD11 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> 'telephone: {2Q9)46&342Q Fax: (209)464-0138 b: . <br /> ENVIRONMENTAL HEALTH <br /> PI=KNIT sERvlcs ` PUB+LIC RECORDS RELEASE P I <br /> APPLICANT: �fSr BUSINESS1AGENCY: CW.SDI i4r <br /> ADDRESS: !Y?M &nT EVd 01y? T CITYISTATERiP: D N <br /> PHONE(1): �--T� T-- ` - -- PHONE(2): 5%0-Q0���.��_ FACSIMILE; 560-Z-U- <br /> 7rNTA77VE*APPOINTMENT DATE: - Time: _ T <br /> (Please allow 10 business day*from data of application submittal-'Tentaa#vv only-must be ConfSrmad) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$122 PEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE GF APPLICANT DATE <br /> Electronic information: [] List©Map,Description: <br /> FILE ADDRESS EHo use ONi Y <br /> street x street Name City <br /> �. G �2-S 2 <br /> 3. <br /> 4, <br /> 8. <br /> _ tlrtlt 4 <br /> 7. <br /> 10. nit s <br /> 8peciflc Data Range of Information Requested: From aR LD to r � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)Ci-FANI P SITE(LOP) ❑HOUSING ABATEMENT S L II3 WASTE FACa rrYIVEMME <br /> OTHER CLEANUP SITE(NON-LLP) ]FOOD FACkrry WASTF TiR€ <br /> UNDERGROUND TANK(MONrrORINGMEMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAXA00U8 WASTE GENERATOR Q CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TtERW PE:RNtTLD FACILRY p MOTELMOTEL PummTRuCIUYARDICKEWCALTOILET$ <br /> TATTOOIBODY PIERCING ❑POOLISPA LAND USF APPLiCATIOM SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRiuAY$:oO AM-5:OOPM(P-XCLUDimo HouiDAYS) <br /> I. Limit go 1:9.1en addresses in the apace 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),4&4-0138 or mail to th6 addMas indica 2n, Address <br /> ranges velli not be accepted-for additional assistance with file addressees,contact the EHD_ Applications recelvsd after <br /> 3:00 pm will be processed the next business stay. <br /> I 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be Confirmed approximately ton(10) <br /> days after receipt of application. The files wilt be hold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is acUveiy being W6rked on by EHD staff may not be immediately available for review. A now 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 END staff at the expense of the applicant. <br /> 4 Future file reviews by the sante applicant may require a$122 deposit prior to review. <br /> EHo use ONLY <br /> eHn�e•oo orrsw+a <br />