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�. 05/63/2010 14:57 4085597.661 AEI SAN JOSE PAGE 01/01 <br /> V_ <br /> MD E EHD LOG NUM112 <br /> DATE RECEIVED, ,;� SAN JOAQUIN COUNTY <br /> t,,,�••: f U t J <br /> ENV <br /> �t�^�� i ENVIRONMENTAL HEALTH DEPARTMENT <br /> EN iR0N' .F,�+ i ���-�`� sQo fast Main St. Stockton, GA 95202-3b29 <br /> PERAl `u�tQ;V s'V' iephone: (209)46$,3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> * r ' <br /> APPLICANT:_ I dl+ BUSINESSIAGENCY: C U <br /> ADbRrz$S: �L�. a yC�IT�-Y,IrSTATMIP: �} <br /> PHONE('I): Zq '5 1 PHONE(2): q0 ��'I 7"l0 b O FACSIMILE: "1 01 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please ailaw 10 bust""days from date of application submlttai-"Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQues-r-I FE (G H R CHE K ONLY) REQUEST PROGESSI o IN 3 BUSINESS DAYS3 <br /> j SIGNATURE OF APPMICANT DATE r l — <br /> I Electronic Information: ❑ List 0 Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name city ©Unit 1 <br /> 2_5 T G 1.UD - ' <br /> II 2. f v 4-V� �Unit 2 <br /> 4. Unit 3 <br /> 4a. <br /> 6. Unit 4 <br /> 7, <br /> 8. <br /> El Unit 5 <br /> 9. <br /> 10• Ll Unit B <br /> .11 <br /> Specific Date Range of Information Requested: From to <br /> i ENVIRONMENTAL HEALTH DEPARTMENT FILES -- <br /> �ONDERGROUND TANK(UST)GLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOUD WASTE FACILIIY/VEHICLE <br /> THER CLEANUP$l7E(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUNI]TANK(MoNEfoRINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AIARDOUS WASTE GENERATOR []CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> mrol <br /> EREo PERMITTED FACILITY LlMOTEIIHOTEL ❑PUMPER TRUCIVARDICHEWCAL TOILETS <br /> 4 ATTOOIBODY PIERCING POOUSPAIn ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FAGLITY �OTHER(PLEASE SPECIFY)011 q�ZVVMYe 14' •p <br /> WELL AND SEPTIC PERMIT RECORDSARPI AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDMG HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(es). At toast one file type MUST be selected. 464.4138 or ddress Indicated0ove, Address <br /># ranges will not be accepted-for additional assistance with file addresses,contact the EH0, Applications received after <br /> C 3.00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EH P files exist. An appointment for review will be confirmed approximately ten(10) <br /> 1 days after recelpt 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 ENI]staff may not be immedlataly available for review, A new application may be <br /> submitted when the file Is avallabte. <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 Sante applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(208)468-3425. <br /> EHD USE ONLY <br /> j <br /> E°HO 60-06 6727109 <br /> 1� <br /> I <br /> f <br />