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01/09/2008 15:01 209334'- '1 WGR 50UTHWE5T NC PAGE 01/01 <br /> DAA I V�Et)-)� � r�.= � 1EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> lP40 t Q 2003 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sjgov,or <br /> Ir,I',;; Ul`dMiLF--N" 1ith'LT H Z 7 <br /> �'E i.It..1.SL �%!..__ CPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I R 1 �- 5 f4<�4A BU51NESS/AGENCY: (A) <br /> ADDRESS: I W C r S Kee j- U t CIA <br /> T- (<_O O�L <br /> PHONE(1): I �J� — 3�e3 PHONE(2): cyCo �o FACSIMILE Q�{ <br /> TENTATIVE'APPOINTMENT DATE: �0 2 c)�—f <br /> Tie: <br /> ((Please avow 10 business days from data of appllcatlon Submittal-•Tentaflve Onlymmust be confirmed) <br /> CHECK DOX TO EXPEDITE REOU ST-598.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 9?SINESS DAYS <br /> SIGNATURE OF APPLICANT DATE / p <br /> Electronic Information: [I List L]Ma'-Description: <br /> FILE ADDRESS <br /> Street x EHD USE ON&1y <br /> Street Name <br /> ��' a k �1 i : f - <br /> 1, ti + J D unit 1 <br /> 3� c-k hrn � X ) <br /> L� �Q L 4) <br /> OV, <br /> 5 �V _Q1L� I Z. ,SSM 14 �1) n 2 <br /> r- <br /> 4 0 I '�J . F � s�teg_ 3 ley, Unit 3 <br /> N <br /> 6• ✓ o - 6 t?k p� \\\I <br /> Unit 4 \ <br /> X 7. <br /> \ $' ❑ Unit s <br /> 9. <br /> 10• unit s <br /> Specific Date Range of Information Requested:From � <br /> to <br /> �,,,// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I NDERGROUND TANK(UST)CLEANUP SITE LOP ❑ <br /> ATHER CLEANUP SITE(NON-LOP) ( ) 0 rOOD F G ABATEMENT LID WASTE FACILRYNEHICLE <br /> �NOERGROUND TANK(MONFTORINGJREMOVAL)V ❑ OOb FACILITY WASTE TIRE <br /> HAZARDOUS WASTEGENFRATOR✓ DOG KENNEL ❑DAIRY <br /> ❑TIERED PERMITTED FACILITY ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TATTOO/BODY PIERCING M MOTEL/HOTEL ❑PUMPER TRUCK/l ARb/CHEM TOILETa CC <br /> ❑MEDICAL WASTE FACILITY O OTHERPDOLI(A 10 LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE$PECIrY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FoR REVIEW- MONDAY-FRIDAY 8:00 AM-5:0OPM -EXCLUDING HOLIDAY& <br /> 1, List up to ten addresses In the space above. Select the type(s)of files from the list above b checkingthe appropriate <br /> box(es). At least one file type MUST be selected. Fax t 20 _464-0139 or mail to the address Indicated abaeAddress <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 appllcation 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> I") :t1_ r <br /> EHD 40.00 Oref2007 <br />