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71/30/2009 17 :54 FAX <br /> 01V ED Ett17 LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> NOV. 3. 0 2009T� <br /> ENVIRONMENTAL HEALTH' DEPARTMANTA <br /> �NN 600 East Main St. Stockton,CA 95202-39. <br /> h`one: (209)4$8-3420 t=ax; (209}464-0138 Web: �. Sjgov.arg <br /> , ft�� RV PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 BUSINESS/AGENCY: <br /> ADDRESS: ��` '-� y \ee7 CUrre C_ CITYISTATEIzip: <br /> PHONE(i): ew -st7_C)?S PHONE(2): (91C)9't{9-28115 FACSIMILE: (� t{$o—o Ga's <br /> IIJ <br /> TENTATIVE*APPOINTMENT DATE: Mme: pg(=%D <br /> (Please allow 10 business days from data of appiioativn submittal-•Tentafivv only-must be confirmed) <br /> [CHECK BOX TO EXPEDITE REQ 15 F (CA OR CHECK ONLY}-BEQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE_ <br /> Electronic Information: ❑ LIS Map—description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stoat# Stmt Name City <br /> z. S L( vV• 1-4IF-6 ❑Unit 2 <br /> 3.µ W. (*AqF- t_t 1z v T ' .fi t <br /> 4. - c (.J, I f�i 3� C. $ <br /> 7. , <br /> l3. <br /> _ 0 Unit 5 <br /> 9. <br /> ©Unit a <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT'FILES <br /> :NDERGRouNo TANK(UST)CLEANUP SITE(LOP) ❑HORSING ABATEMENT {�SOLID WASTE FACILITYNEHICLF <br /> =US <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY . ❑WASTE TIRE <br /> OUNn TANK(MONIrgRING/RQAOVA0 ❑DOG-KENNEL ©DAIRY <br /> WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PEW17 TED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDIGHEI rAL TorLus <br /> ❑TATTOOMnoy PIERCING ❑PwUsPA {]LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0015101(EXCLUDiima HOLIDAYS <br /> 1. List up to ten addressu In the space above. Select the typo(:)of files from the list above by checkinD the appropriate <br /> box(es). At least one file type MUST be$elected- Fax to(2491464-0138 or mail to the address Indicated,g¢,qv, Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. App]icatlons 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 tan(10) <br /> days after receipt of application. The files will be held fora 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 retumed in the same condition as released will be reorganized by E:HD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to'ravlew. <br /> 5. if you need further assistance,please contact Diane Martinez,at(249)458-3425. <br /> EHouaeoreF`v <br /> A <br /> EHD 40-06 &27109 <br />