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Sent By: ORSWELL & KASMAN, INC. ; 626 932 1807; Dec -15-09 9:40AM; <br />11 =70 SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />ULi, 1 5 2009 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e <br />ENVIRONMENT HEALTH <br />PUBLIC RECORDS RELEASE APPLICATION <br />D�Dan1T/ccf?ulr�� <br />11 <br />Page 1/1 <br />EHD LOG UMDE <br />APPLICANT:_ I Y��Z G�.o`"'SGC�BUSINESS/AGENCY: <br />ADDRESS: w t'st' p'a (Na CITY/STATE/ZIP:ZT1r' <br />C/E X1014 <br />PHONE (1): Ggc I.`�� J �� PHON '(2)• _ FACSIMILE: 3a=130 7 <br />TENTATIVE'APPOINTMENT DATE: Time; <br />(Plaaso allow 10 business days fro W of application 9dbrnIttaI -'Tentative only -must be confirmed) <br />CHECK BOX TO EXPEDITE REUILIES! - $11b FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSIN SS DAYS <br />SIGNATURE OF APPLICANT DATE I � I5/ Oi <br />Electronic Information: ❑ List ❑ Map – Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />ENVIRONMENTAL <br />Street # Street Name <br />5 �s Ci,Nc7 <br />3a Jnr 1wl� <br />Unit 1 <br />u.h' <br />City <br />�� <br />2. <br />y <br />a 4 L4 I �(V �5� a cY _. W u i <br />oc %lcN <br />�C7 iE�,_ CTUnit z <br />3. <br />IbQW Yty` C4_ <br />v <br />�_ (iE�iti'U�ti <br />a. <br />�7y CvvY <br />Al C <br />1 _.. �Q 1 tv� .. <br />S� k <br />q� h <br />.-..... �..11L1�L� <br />�E 5/ Unit 3 <br />Ia' <br />nit <br />6.VP <br />7. <br />f3. <br />❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED <br />ATTOOIBODY PIERCING <br />- L] unit s <br />[I LAND USE APPLICATION SITES <br />F] MEDICAI. WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />�— <br />10. <br />[IUnit G <br />pild <br />Specific Date Range of Information Requested: From <br />to - <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ HUUSING ABATEMENT <br />❑ FUUD FACILITY❑� <br />❑ SOLID WASTE FACILITYNEIIICLL <br />WASTE TIRE <br />UNDERGROUNUTANK (MONITORINGIRF.MUVAL) <br />❑ DOG KENNEL <br />DAIRY <br />[� WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />TIERED <br />ATTOOIBODY PIERCING <br />❑ POOLISPA <br />[I LAND USE APPLICATION SITES <br />F] MEDICAI. WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE; AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPm (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 th dctross 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 appolritment 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. Appointment$ <br />should be scheduled accordingly. <br />3. A file that is actively being worked on by EHO staff may not be Immediately available for review. A now 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) 468-3426, <br />EHDUSEONLY <br />�'' f�IIlJlfh '%�1�►Iafii <br />8127109 <br />