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08/19/2010 06:34 FAX 9188529132 . Geocon Consultants �]0©11001 <br />' DATER <br /> SAN JOAQUIN COUNTY EMD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y <br /> 600 East Main St.Stockton, CA 95202-3029 <br /> x(209) 468-3420 Fax; (209) 464-0138 Web: www.sjgov.or 1 hd <br /> 9 I/A <br /> X11 -.Sk\ PUBLIC RECORDS RELEASE APPLICATION <br /> APLICAI+IT: 4 C.w ( ACIi..t BUSINESSIAGENCY:_G� s�t•�CCpk1 s t <br /> ADDRESS: ` ('] �G7 CITYISTATERIP: , rxp,ra.('� C4c(Z, <br /> PHONE(1): G) SSZ--I{I ( e, PHONE `�` <br /> TENTATIVE*APPOINTMENT DATE;_ 8 -2 q..-co- Time, I <br /> (Please allow 10 business day$from date of application submittal-'Tentat1ve only-must be confirmed) <br /> SljCHECK BOX TO EXPEDITE REQUEST-$122 tM(CASH OR CHECK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG Al <br /> OF APPLICANT_ ( DATE <br /> Electronic Information: ❑ List❑Map—Description, <br /> FILE ADDRESS EHD USE ONLY <br /> str$$k S Street Namo city <br /> Unit 1 <br /> D I 4 r iuoP- r rjisr]C�IC 7 1 <br /> 2. nit 2 <br /> s. 23 t 57- <br /> 4. rj 2 AP.bK �aJ `F y n E#3 1 <br /> 5- 4 141-74-10 , <br /> r: <br /> a. <br /> []Unit 8 <br /> 9. <br /> S IfI Di ng !tea Requested. From to _ <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> IUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ADATEMENT NRSOLID WASTE FACI <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY D9 WASTE TIRE " 'd <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER T"REATIAENT PLANT <br /> TIERED PERMITTED FACILITY MOTELMOTEL PUMPER TRUCKNARDICHEMECAL TOILETS <br /> TATTOOMODY PIERCING ❑POOL/SPA LAND USE APPLICATION SITES <br /> K MED;CAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA6I.E FOR REVIEW: MONDAY-FRIOAY 8:00 Am-5:00w_(EXCLUDING HOLIDAYS) <br /> 1. 11_1,�t up-to ten addresjj In the space above. Select the type(s)of files from the I[st'above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0�i�mall to the addmes Indicated above.I 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 clay. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately tan(10l <br /> days after receipt of application. The files will be held for a maximum of five business days far review. Appointments <br /> should be scheduled accordingly. <br /> 3. A flle that Is actively being worked on by EHO staff may not be immediately avallable for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned In the Dams condition as released will be reorganized by EHD staff at thP'mg� <br /> a f the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review,CN6119E QNLY £C ' � '�� Aft <br /> La�. <br /> MHO 45-09 07120110 <br />