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Sent By: ORSINELL & KASMAN, INC. ; 626 932 1807; Dec-15-09 9:40AM; Page 1 /1 <br /> T <br /> � ��JLSLI �D EFID LOG UMDE <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ULL, 1 5 2009 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax. (209)464-0138 Web: www.sjgov.org/eh <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> -- <br /> PE <br /> APPLICANT:) /✓�c'k_ I `YaSGt�� BUSINESS/AGENCY: � �' /<0�04' <br /> ADDRESS: w�S W cw4 <br /> CITY/STATE/ZIP: �,' t CA 0�b <br /> PHONE(1): �a� 9` a goo PHON (2)' R FACSIMILE: (";Ze 7 <br /> TENTATIVE'APPOINTMENT DATE. Time: <br /> (Ploaso allow 10 business days fro to of application sdbmittal.•Tenfadve only•must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REUUE:S I -$1 lb FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 DUSIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 1 <br /> C Y CY a V J0r OCL on <br /> �� / `' r <br /> 2, L}L4( YV L5� o cY W a Cl Unit Z <br /> r <br /> 4. r^y Couv� S�q�k �: Unit 3 Ole <br /> 1 �, - <br /> 5...... Y 4..x_1 akv` _. <br /> 6. 3� Y%Y( nc o� nit4 <br /> l _ <br /> Ix <br /> 7. vo Y�vt S - <br /> g []unit s <br /> 9. _ <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tj UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEIIICLC <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIRFMOUAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR []CHICKEN RANCII ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> AT'foo1BODY PIERCING [:1 POOL/SPA ❑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(EXCLUDINo 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 F_HD will notify the applicant if any EHD flies 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 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 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY .. _.__.. <br /> ^--� --� --� 8!27/09 <br /> EHD 48-08 <br />