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From:Marcus H. Bole & Associ16 530+633+0119 12/0&09 16: 12 #140 P.001 <br /> MOWED(�ED EHD LOG NUMBER <br /> ��1��1 L�'�IL1�1lp SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT „ <br /> 0 7 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRUNMtNTHEALTITIelephone: (209)468-3420 Fax: (209)464-0138 Web:WWW.Sjgov.o <br /> 4 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Z&(/ BUSINESSI42L <br /> Ll <br /> "✓i- <br /> ADDRESS: 107 +/"�r0�k !/Y/J-C� city/State/Zip C�Z1 eZ_J//ar3iZ <br /> PHONE(1): IQ l/Z PHONE(2):e 30-[ZIT— CG l�x,l Id FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: -� 7 /hur-t Time: F"130 <br /> (Please allow 10 business days from da a of application submittal--Tentative only.must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASHOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE �l�Zt <br /> Electronic Information: ❑ List❑ Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street It Street Name City ❑ Unit 1 <br /> 4� ell <br /> [I unit 2 <br /> 3. t3 <br /> 4. Sul J'1 / dd <br /> 5. ��. //$ Yr J ❑ Unit4 <br /> a`5 5 0 ✓�� <br /> 7. p /( nit 5 <br /> 8• 12 0 JIL <br /> 9. <br /> 10. p - Ll' C/a <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ISI U�DERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 1'2-SOLID WASTE FACILITYNEHICLE <br /> 1,-OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑WASTE TIRE <br /> Qtt/H ERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 13 DAIRY <br /> AZARDOUS WASTE GENERATOR O CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> •TIERED PERMITTED FACILITY O MOTEL/HOTEL 13 PUMPER TRUCKNARDICHEM TOILETS <br /> •TATTOOIBODY PIERCING 0 POOLISPA E3 LAND USE APPLICATION SITES <br /> •MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 6'00 AM-5:00PM - EXCLUDING HOLIDAYS, <br /> 1. List up to ten addresses 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(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not he 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 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 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 48-06 6104106 PUBLIC RECORDS RELEASE APP FORM <br />