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01/15/2010 11:54 51065 ENVIRON PAGE 02/02 <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTYCI ID I OG NUMBER <br /> VFDENVIRONMENTAL HEALTH DEPARTM NTS <br /> 600 East Main St. Stockton, CA 95202-302 <br /> IAN 1 5 2010 Telephone, (209)468-3420 Fax: (209)464-0138 Web: WWW,Sigov.org/eh <br /> ENVIl7�1QPI TId <br /> JIT I If A PUBLIC RECORDS RELEASE APPLICATION <br /> }f,��e��,��� <br /> PERWI �N I-1p.I�1� l�S�SU A,►.S BUSINE$$/AGENCY:S-N�V-(2� <br /> ADDRESS: I 1 I�,fuOVIJ�7 _ C"ISTATE/ZIP:�� � �[-�ICA�� <br /> PHONE(1):(5LQ Q^x,1501 PHONE(2),—/ FACSIMILE:4SLQ�(p'�S—CI j1-7 <br /> TENTATI VES'APPOINTMENT DATE:� � � �"20k n Time; <br /> (please allow 10 business days from date of appllca Ion submlttai-*Tentative only-must be confirmed) <br /> C�CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT AQtO n <jta1_a 1PA _ DATE <br /> Electronic Information: [J List❑ Map Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 1! Street Name City <br /> ,. ❑Unit 1m <br /> _�"_... c-Sk Ginfix- ,ear ��[ -{p I `7L�0 <br /> 2. <br /> - nit z <br /> 4. <br /> 5. ^ - JR<t 3 <br /> 6. <br /> - _-..,.....,...._,...,.,,,.. Unit 4 <br /> 7. ... <br /> ❑Unit 5 <br /> 10 <br /> Uni# <br /> Specffie Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING A13ATEMENT SOLID WASTE FACII.ITYNEI IICLEA- 14/7 i <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILrTY WASTE TII2C " 4 lam( <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL DAIRY i <br /> HAZARDOUS WASTE GENERATOR . <br /> ❑CHICKEN RANCH PM1 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTEL/HOTEL PUMPER TRUCKIIIARDICHEMICAL TOILETS <br /> ��TATTOOMODY PIERCING Q POOLISPA LAND USE APPLICATION SITES <br /> V MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) 6 <br /> WELL.AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY+RIDAY 8,00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the,space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fa to 209 464-01.38 or mallto thg address indicated above, Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the PEP, 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 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> F?WD Uat�QNLY <br /> EHD 48.06 <br /> 0/27/09 <br />