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/ Fpr, 19. 2010 11 : 20AM R i n c o n Consultants, Inc. No. 7000 P. 1 <br /> aC '�E <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> J iU ENVIRONMENTAL HEALTH DEPARTMENT <br /> B <br /> , 600 East Main St. Stockton, CA 95202-3029oq <br /> Elu �!11.Z; i ,--EA hone: (209)468-3420 Fax: (209)464-0138 Web: vwvw,s19ov.or <br /> PER All 1,i'SERVIJLES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (XVzk I �p BUSINESS/AGENCY; <br /> ADDRESS: <br /> CITY/STATE/ZIP: Ueda c <br /> PHONE(1): v (o - / fit-( <br /> `�( � I v06 _:_PHONE(2): FACSIMILE: 0S <br /> TENTATIVE'APPOINTMENT DATE, _ <br /> (Please allow 1e business days fro m data of application submittal•'Tentai/ve only-m 9t be confirmed) <br /> — <br /> ❑CHECK BOX 70 EXPEDITE RE EST-$115 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE (� <br /> Electronic Information: ❑ List Map–Description: <br /> -- _ FILE ADDRESS AHD USE ONLY <br /> Straet 0 Street Name <br /> City <br /> tAA h Unit 7_ <br /> c ) J <br /> 3. r�-- --- _ a unil.z <br /> a. <br /> --- <br /> �' SCC— <br /> ownit 3 <br /> OOP <br /> 7. <br /> - <br /> 8. i - <br /> 9.: ❑Unit 5 <br /> 10. 1 I – <br /> Specific Date Range of Information Requested: From ❑Unit 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES to <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> 9NDERGROUND <br /> THER CLEANUP SITE(NON-LOP) QC]SOLID WASTE FACILITYNEHICLE <br /> TANK(MONR ) ❑DOG ORINGIREMOVAL El DOGFOOKENNEL FACILITY ❑WASTE TIRE <br /> HAZARDOUS WASTE GENERATOR DAIRY <br /> TIERED PERMITTED FACILITY Q CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TgTT0018oDY PIERCING ❑POOL/SPA ElOTELf HOTEL PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY ❑LAND USE APPLICATION SITES <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-913 or mall to th address indicated <br /> ranges will not be accepted-for additional assistance with file above. Address <br /> 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 i$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)468-3425, <br /> — EHD USE ONLY <br /> EHD 48.06 <br /> el2,�aa <br />