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6/30/2009 11:38 2054728E INSITE ENVIRONMENT - PAGE 01/01 <br /> 'r tvx>z 1 V EHD LOG NUMBER <br /> ; ! SAN JOAQUIN COUNTY <br /> } ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 3 a 2069 600 East Main Street, Stockton, CA 95202-3029 / C <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.or ' /t Jl <br /> EN`JRONt1ENT L!EN.TH <br /> PER !I"E^ PUBLIC RECORDS RELEASE APPLICATIONc C 1 / <br /> APPLICANT: Po-kill YL BUSINESS/AGENCY: kJt1L C 6A'j%rp'1g00rL" <br /> ADDRESS: e <br /> �CittylStatL0P10a� <br /> PHONE(1): Zbq- t{7Z-' a(aSO PHONE(2): kombei5@.Ills Cif-env,rn ItSIMILE: X0'1-47Z- O6SI <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal•"Tentative only-must be confirmed) <br /> Cl CHECK BOX TO EXPEDITE REQUEST-$105 FEE CASH ORfiM4E9K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L�6'20 0ea DATE <br /> Electronic Information: ❑ List© Map-Description; <br /> FILE ADDRESS EHD USE ONLY <br /> street Street Name City ❑ Unit 1 <br /> �. fib^ r��,I* ��t <br /> 3. <br /> 4 Unit 3 <br /> 6. Unit 4 \ <br /> 7 11004 <br /> �\ <br /> 6 ❑ Unit 5 <br /> 9. <br /> Unit 6 <br /> 70. <br /> Specific Date Range of Information Requested: From 1171 C6 0 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERGROUNO TANK(UST)CLEANUP SITE(LOP) Ll HOUSING ABATEMENT \M SOLID WASTE FACILI YNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL 13 DAIRY <br /> m HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOOBODY PIERCING ❑POOLISPA Cl LAND USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY 17 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:80 AM.5:00Pm - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from thelist above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax to(2091464.0138 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 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 68.06 8104108 <br /> PUBLIC RECORDS RELEASE APP FORM <br />