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06/30/2009 11:38 2094728f" INSITE ENVIRONMENTAL PAGE 01/01 <br /> END LOG NUMBER <br /> I SAN JOAQUIN COUNTYI/i�1 D, ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 3 0 2009 600 East Main Street, Stockton, CA 95202-3029 C� <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www,sjgov.or 5 <br /> ttv`lllattI ISER ,IEr,S PUBLIC RECORDS RELEASE APPLICATION <br /> PE.IM,T S�P'I [� <br /> APPLICANT: G-A)� v� ` BUSINESSIACG�ENCY: IS <br /> nl�t C:„�Ytro�A(bItr / <br /> � <br /> ADDRESS: ^{ �yrt�fiLl c.c�[✓o �Yi tU CitylstatLs/ZIP S}v ( G+rt ai SZI 10 1 <br /> PHONE(1): Z0q- tf�_F!(ASO PHONE(2) EQCW11nq�.1'tLS ftf-en"" SIMILE: Q-0—L17Z' O�65! <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEES CASH ORfiMqqK ONLY)-REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT [ /s rr DATE eel q 6/'o q <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street• Street Name city ❑ Unitll <br /> 2. E-Moai) S* � aGt/ ❑ Unit <br /> 3. <br /> 4 Unit3 ((( <br /> 5. <br /> fi. <br /> Unit 4 \ <br /> 7. <br /> ❑ Units <br /> 8. <br /> 9. Ok <br /> unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT M SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NDN-LOP) ❑FOOD FACILITY D WASTE TIRE <br /> \ UNDERGROUND TANK(MOWTORINGMEMOVAL) D DOG KENNEL 13 DAIRY <br /> m HAZARDOUS WASTE GENERATOR D CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY D MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> D TATTOOBODY PIERCING D POOL/SPA 71 LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FAOILIrY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-S:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addrasses 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[2091 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 Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff atthe expense of the applicant <br /> Future file reviews by the same applicant may require a $iD5 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 68.06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />