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Mar 03 2010 1 : 42PM TUE UPS STORE #2503 9167.251772 P. 1 <br /> I <br /> v `"r <br /> AHD LOG NUMBEf2 <br /> SAN JOAQUIN COUNTY <br /> LO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �� 800 East Main St.Stockton, CA 952023029 <br /> one: (209)488-3420 Fax: (209) 4840138 Web:wow,sjgov.org/ehd <br /> w PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: v < <' 13USINESSIAGENCY: <br /> ADDRESS: JQ i ...(ra..G«�e. �/ CITYISTATEIZIP-ee-�--' eo" <br /> PHONE(1): 1%4r7 - 36&C-PHQNE(2): - FACSIMILE: 268 - � <br /> TENTAT/WE PAIS OINTMENT DATE: Time: <br /> (PI se allow 10 bush**-days from date or appnastlon submittal-'Teantsdve only-must be continned) <br /> ❑CHECK BOX TO EXPEDITE REM -f1 i 8 EE (CAS 0 CH6fK ONLY)-REQUEST PROCEZISE0 IN 3 B INE s DAYS <br /> SIGNATURE O APPLICANT DATE Itj <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> $treat 9 Street Name City Unit 1 <br /> 2. —9-9 4, t , 'e unit 2 <br /> /1 <br /> yam.- --- <br /> -- 1 <br /> 4. _ Lam+ /Unit a <br /> g• .� "1 4'0­6 9 — /Unit 4 <br /> 7. <br /> 8. _ ❑Unit ii <br /> 9. <br /> 10, <br /> /Unt1j <br /> Spec Hie Date Ranps c 0 Information R.squsetad: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TAN (LIST)CLEANUP SITE(LOP) ❑HOU81Nn ABATEMENT '$OLIO WASTE FACLrNIVEHICLE <br /> OTHER CLEANUP SIT (NON-LOP) ❑FOOD FACILITY WASTETIRE <br /> DGAINDERGROUND TAN (MONITORIKWREMom) ❑Doe KENNEL PDAIRY <br /> CH–AZARDOUS WASTE ENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TeRED PERMITTED FACILITY Q MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTQDl8ODYPIER 0 ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE F ILITY ©OTHER(PLEASE SPECIFY) <br /> WELL ASID SEPTIC 3FRMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY�FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ton a0dresses In the space above. Select the type(*)of flies from the[let above by checking the appropriate <br /> box(es). At leas one file type MUST be selected, Fax to(2091484.0138 or malt to the address Indlosted shove. Address <br /> ranges will not I a accepted-for additional assistance with Me addresses,contact the EHD. Applications received after <br /> 3:00 pm will be I roaessed the next business day. <br /> 2. The EHD wilt no fly the applicant If any EHD ales exist, An appointment for review will be cormrmed approximately ton(10) <br /> days after recoil t of application. The files will be held for a maximum of five'busirx"days for review. Appolntrnents <br /> should be sche tiled accordingly. <br /> 3, A fl that Is actl aly being worked on by EHD staff may not be Immediately mvallable for review. A new application may be <br /> submitted when the file Is available. <br /> 4, Any file not rettr nod In the same condition ae released will be reorgantW by EHD staff st the expense of the appilcant. <br /> Future file ravie ve by the some applicant may require a$118 deposit prior to review. <br /> 5. If you need further Assistance,pisase contact Diana Martinez,at(209)468.4426. <br /> !MD usil ONLY <br /> EMD+a•oa <br /> amroa <br />