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02/12/2009 00:09 FAX 9163722565 WALLACE-KUHL AND ASSOC. 0 001 <br /> DATE RECEIVED 101 EHD LOG NUMBER <br /> MD <br /> UNTY <br /> W�� �I �',E SAN JOAQUIN CDD ENVIRO MENTAL HEALTHODEPARTMENT <br /> FEB Z 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgoV. r d t <br /> 13 <br /> ENVIRONMEN t I iEALTH PUBLIC RECORDS RELEASEAPPLICATION <br /> PERS 411�2ER 11GES <br /> APPLICANT: 43GN /1 G 1-64,yoAi BUSINESS/AGENCY: W��-�GL " /�L/�L f Ars-eC. <br /> ADDRESS: _p32� ( �t�E-Ac bN 6kuD City/State/Zip WEST' SAoGp_A mi—wN-i ,C <br /> yA r <br /> PHONE(1): t f L — �J 12 114-7-1' '+ G <br /> PHONE(2): FACSIMILE: 1 16 3-7,' 25 (0 S <br /> TENTATIVE*APPOINTMENT DATE: -2 ' B Time: T• 00 A-A-4 <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDIT(R UEST•$1 FEE OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> GoRRR'�--,,p LGoc� <br /> 2. 2050 OLLY D1✓ig Y' � 'o? � � � oZ��D ❑ Unit <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> ?OOLIn 4 <br /> 6. <br /> 7. <br /> ❑ Unit5 <br /> 8. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ,// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WN <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) 11HOUSING ABATEMENT 13SOLID WASTE FACILITY/VEHICLE <br /> ER CLEANUP SITE(NON-LOP) M FOOD FACILITY 13WASTE TIRE <br /> ERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH d WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA 13 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 EHD 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 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />