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01/15/2010 11:54 5106554517 ENVIRON PAGE 02/02 <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY EI -ID LOC NUMBER <br />D <br />�E V L LDJ ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />��� 1 5 ZQj� Telephone; (209) 468-3420 Fax: (209)464-0138 Web: www,sigov.org/eh <br />ENVI PUBLIC RECORDS RELEASE APPLICATION <br />�'• I i ILnLI I I <br />P <br />� P'0 4 N A ((' 4-( kini'-*) A_t BUSINESS/AGENCY: N�% <br />ADDRESS: �� E(,�, u�� E�dO CITY/STATE/ZIP:i� (-"c--,CA 3_ <br />PHONE (1):jp Q - 2SD PHONE(2). FACSIMILE: (SLO� (�S S -GSI`7 <br />TENTATIVE" APPOINTMENT DATE: 12 p t n Time: 3: 5Dp m <br />(Please allow 10 business days from date of appllca Ion submittal - "Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $115 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �Ql �a te- DATE_UJSL:2 <br />Electronic Information: ❑ List ❑ Map — description: <br />FILE ADDRESS EHD USE ONLY <br />Street # StreetName City ` <br />'�i�✓AD Unit 1 <br />v _�....232s �.1e�s� Clan - ur Mock -fah N,,� G�Es,Ajo mi <br />2. <br />3. - — —VoKnit2 <br />4. <br />S. rtIt 3 <br />6. Unit 4 <br />7. <br />8. _,,.• <br />—......... <br />.. _.. T_.._,...._._.. ❑ Unit 5 <br />9. <br />10. <br />Specific Date Range of Informatlon Requested: From'li <br />ENVIRONMENTAL HEALTH DEPARI <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />UNDERGROUND TANK (MONITORING/REMOVAL) bL <br />❑ DOG KENNEL <br />WASTE GENERATOR of <br />❑ CHICKEN RANCH <br />9HAZARDOUS <br />TIERED PERMITTED FACILITY <br />Q MOTEIJHOTEL <br />TATTOOtBODY PIERCING <br />❑ POOLISPA <br />V MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE- SPECIFY) <br />,-- to _t"cKA CJl a <br />Lo <br />SOLID WASTE FACII.ITYNEI IICLE <br />WASTE TIRE <br />DAIRY <br />WASTEWATER TREATMENT PLANT <br />PUMPER TRUCKII(ARDICHEMICAL TOILETS <br />LAND USE APPLICATION SITES <br />WELL. AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8.00 AM-6:00PM (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. Fa3 to 209 464&1,38 or mailto headdress 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 $115 deposit prior to review. <br />5. If you need further assistance, please contact Diane Martln®z, at (209) 466-3425. <br />