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04/09/2010 09:44 9257466099 ALT CONSULTANTS , 175A.GE 011.01 <br /> f D EHD LOG NUMBER <br /> V SAN JIQUIN COUNTY . <br /> ENVIRONMENTAL HEALTH DEPA,RTMENT- <br /> ': �. J 600 Fast Main St. Stockton, CA 95202-3029 <br /> E X11 ON NP11: (dphone: (209)468-3420 Falx: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERNAITISER'vr'JES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> KIM r�n SUSINESSIAGENCY: El <br /> _ <br /> ADDRESS: X550 CAbaa CITYISTATEIZIP:w /�� c- �C'A`q`f 5`7- <br /> PHONE(1): 2- PHONE(2):_ ,ID ;_��'.0^ FACSIMILE: � 14 b 'f <br />,i TENTATIV "APPOINTMEN ATE: Time: <br /> (Pfease allow 10 4usine9s days from data of appllcatfon submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPE4iTE;REQUEST-$115 FE SH OR CHECK ONLY)-F2EQUES7 PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: Q List F_1 Map-Description: <br /> FILE ADDRESS EHD USE QNLY <br /> Street# Street Noma Clty 0 unit i <br /> Z I(a �Nor11L- <br /> 3. I p _ b r i'h r`Yl Gu r1 S fr t' <br /> 4. Lod i units ,Ili <br /> s. 29 N 6 r-+k '- }tDc�K11 =� �.add <br /> $. (7 C 1�e vl. T _ �� ; :� ,` Unit 4 <br /> 8. N 01r`1' 1 Lo Ct-- M unit 5 <br /> 10. <br /> Specific Date Range of Information Rpquostad: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ©HOUSING ABATEMENT SOLID WASTS FACIt_ITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ®WASTE TIRE <br /> UNmRGRouwD TANK(MONITORINGfREMOVAL) DOG KENNEL. DAIRY <br /> HAZARDOUS WASTR GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEIIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> �TATTOo/BODY PIERCING ©POOUSPA ❑LAND USE APPLICATION SITES <br /> ® MEDICAL WA5TE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> ,. �.. DAY mo Am-5:00pM(EXCLUDING HOLIDAYS) <br /> WEI.I,A14p SEptIC PERMIT REGOfiS1S ARE AVAILABLE FOR REVIEW' MONDAY-FRC <br /> 1. Ugt Up to <br /> t_eaAddM&seA in the space above.,Select the type(s)of-flips from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Eax_to_fZ0R)4ti4Oa,3.0r mail b2.the adores irldicatad above._ Address <br /> ranges will not be accepted-for additional assistanca 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 behold for a maximum of five business days for review. Appointments <br /> should be schadulad 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 a5 released will be reorganized by EHD staff at the expense of the applicant. <br /> Future filo reviews by the some applicant may rectuire a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(2a9)466-3425. <br /> EHO USE ONLY <br /> I e <br /> EH0 49-OG Sl27109 <br /> w, Ii •. <br />