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02/12/2009 00:09 FAX 91637225E WALLACF-KUIIL AND ASSOC. �� - 0 001 i <br /> DATE RECEIVED - SAN .10AQUIN COUNTY EHD LOG NUMBER <br />+` `1 ��E� ENVIRONMENTAL. HEALTH DEPARTMENT <br /> FEB 12 2009 800 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web. www,sjgov. r d <br /> 3 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION r <br /> PERnnIT�lUr, <br /> APPLICANT: Gj 44c Z_,=k V0A18U51NE55lAGENCY; CA/�Q'4't-AG� Ll4'L E Arree- <br /> 1� <br /> ADDRESS: 32-S-) ca <br /> I EAe-6tj MIVD CitylStatelzip W*-ST SSG 011:s"W C_A � <br /> PHONE(1): G 3 7 Z'1__j+-f3 PHONE(2): FACSIMILE-. 916 3-7-L 25 (.S <br /> T"TENTATIVE"APPOINTMENT DATE: -2 ' 1 I Time: ! • d 6 A-M <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDIT R ?UEST-$l FEE OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �' X07- 'Q 9 <br /> (Electronic Information: 0 List❑ Map--Description: <br /> FILE ADDRESSEHD USE ONLY <br /> Street astreet Name City <br /> .5,. G.RAM. tIOZZOW Unit 1 1 <br /> 2. 20500 pLGY PAC✓igRGA' 3�a , a 9�.5 294411 EJnll2 <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> 6. <br /> 7. <br /> © Units <br /> 8, <br /> 9. <br /> © Unit 6 <br /> 10, j <br /> Specific Date Range of Information Requested: From to P ' .09 <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I/U ERGROUND TANK(UST)CLEANUP-SITE(LOP) M HOUSING ABATEMENT 11 SOLID WASTE FACILITYIVEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 11 WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ©DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY _13 MDTELMOTEL 0 PUMPER TRUCKIYARDICHEm TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 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 209 464-0138 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 END will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt 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 8104108 PUBLIC RECORDS RELEASE APP FORM <br /> -a <br />