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iL .%JIC1 VCLJ KGu It Com' "' ' ,V)F1 <br /> DATE R1_HrE2 U 201 I SAN 44 EHD LOG NUMBER <br /> - .1OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH DEPARTMENT <br /> Attn: C11,I MIT/SERVICES 600 East Main St. Stockton, CA 95202-3029 <br /> (p 209.468.0339) <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ BUSINESSIAGENCY: AC-1 5K(4�Kk s <br /> ADDRESS: 2500 Camino Diablo CITYISTATEJZIP: Walnut: Creek, CA 94597 <br /> PHONE (1): 92$-746-6040 PHONE(2):031)21,Z- V�WS5 FACSIMILE: 925-746-6099 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-3122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 51GNATURE OF APPLICANT4; DATE I ZjZo�I <br /> Electronic Information: ❑ List[] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Stroat Name City Unit1 <br /> Vo,+Ii i t `�dw 5� _WIFE <br /> 2. Unit 2 <br /> 3. <br /> 4. <br /> 2 Unit 3 <br /> 6. <br /> Unit 4 <br /> 7. <br /> 8. I �/ <br /> Unit S <br /> 10. <br /> Unit 8 <br /> Specific Data Range of Information Requested: Fromler-orris Ori T 1_e. to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) �OUSING ABATEMENT -SOLID WASTE FACILITYIVEHICLE <br /> EOTHER CLEANUP SITE(NON-LOP) ❑FOOO FACILITY ---EI VASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAU ❑DOG KENNEL -•F�JUAIRY <br /> ' <br /> ,EDAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHO'rEL -PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING OPOOLISPA 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 12091 464-4138 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 bo <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$122 deposit prior to review. <br /> EHO 115E ONLY <br /> EHD 43.06 <br /> 07129!10 <br /> TO/T0 ]9dd S1NVi-inSN00 ISd 66099bL566 81:9T TTOZ/OZ/ZT <br />