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From:Marcus H. Bole & Assoc 6S 530+633+0119 12110009 16: 12 #140 P.001 <br /> r(�QF�,f VED EHD LOG NUMBER <br /> IILLIII^ltt{IIIICp�9'IU�I��g1UNp�,F171tL�� SAN JOAQUIN COUNTY <br /> >. 0 7 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 7,e 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONMtNT HEALTITPIephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.o <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION o q <br /> APPLICANT: . v - BUSINESSIAGENCY: C,/fr:✓L <br /> ADDRESS: 2�J �Y'O�k !//"/✓'e Clty/statelzip e�Llx-'ez l//Gr'cf <br /> PHONE(1): -531)-6,3q-dl/ -7 PHONE(2):,5 !-/r- C-0 -)�L�wId FACSIMILE: js'O Yo33'"O//9 <br /> TENTATIVE`APPOINTMENT DATE: -��i7 /hw-t Time: 9.30 <br /> (Please allow 10 business days from dale of application submittal-'Tenfative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OORR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� CL) f DATE /����Z <br /> .12 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name 'City ❑ Unit 1 <br /> 2� <br /> 1. g.;) <br /> / �� O✓ YI cY o u� n j <br /> t5f F / <br /> 2. .;) / ' // .G. a ❑ Unil2 <br /> 3. <br /> 4. �[ i C 2 <br /> 5. �. J� ^ ❑ nit 4 <br /> - <br /> T• / /1 nts <br /> 8. p <br /> 9. Unit 6 <br /> 10. 0 C1/ar l J <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT F <br /> FIILES <br /> L_'/UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> 4A ETOTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY 13 WASTE TIRE <br /> Q-tf ERGROUND TANK(MONITORING/REMOVAL) M DOG KENNEL M DAIRY <br /> IAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEUHOTEL M PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOOIBODY PIERCING 0 POOLISPA 13 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 171 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:0OPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types)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 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 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 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />