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004//27/2009 16:16FFAX 916 817 474Q R D R ENGINEERING X001 <br /> 1�, J DELJI EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> P,PR 2 7 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> �1 NEA 600 East Main Street, Stockton, CA 95202-3029 <br /> �NVIR01� I eephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgo <br /> PER SEfkV4CES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANIT: v rt tM ' BLISINESSJAGENCY: 6b{� <br /> ADDRESS <br /> City/State/Zip t_ So M 115 <br /> PHONE{i _�l "S,�' 2 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOIITTMENT DATE: ---/a oci _ _ Time: <br /> (Please allow 19 business days from date of apeatlan submittal-'Tentative only-must be confirmed) <br /> ❑�CHECK BOX TO EXPEDITE REQUEST-$105 FEE(GASH OR CHECK ONLY)-REGUEV PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATPRE OF APPLICANT DATE -2Q <br /> cl <br /> Electror Ic Information: ❑Llst❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> f-27 <br /> Street Name COY ❑ Unit 1 <br /> 3V+wyF � L�, HA'-' eyj �S`it7GY�VP-.3 ❑ Unit2 <br /> 3. � N. HWV 19 S-raG � l <br /> Unit 3 \ <br /> 4. q oI rv. rivv q� ro �.] <br /> uni)14 <br /> 6. i ,�^f U. Oil <br /> ❑ Unit 5 <br /> 9 Y ❑ Unit 6 <br /> 10. ' <br /> Specific Date Range of Information Requested:From __ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERIOUND TANK(UST)CLEANUP SITE(LLP) 17 HOUSING AsATFMENT M SOLID WASTE FACILTTYNEHICLP. <br /> 17THER 14EANUP SIZE(NON-LOP) Q FOOD FACILITY WASTE TIRE <br /> 7 NDER�RUUNDTANK(MONITORINGJREMOVAL) ❑Dor,KENNEL D DAIRY <br /> 4 HAiAR Ous WASTE GENERATOR ❑CHICKEN RANCH ©WASTEWATER TREATMENT PLANT <br /> O7IERED ERmmEDFAcILrrY MM0TEQHOTEL 13 PUMPER TRUCKIYARDICHEMToILE'rs <br /> E3 TATT ODY PIERCING 17 POOLJSPA ❑LAND u5ii APPUCATION SITES <br /> MEoIC1 L WASTE FAcIu ry la OTHER(PLFASE SPECIFYy <br /> a <br /> q WELL AND SEPTIC PERMIT RECORDS ARE AVARABLE FOR REMEW - MONDAY-FRIDAY 8-09 AM-5:00PM - EXCLUDING oUDAW- <br /> 1. List i p to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box{(s). At least one file type MUST be selected. Fax to(209)'464-0138 or trail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the FHD. Applications received after <br /> 3:00 m wit) be processed the next business day. <br /> 2. TheHD will notify the applicant if any EHD files exist.,An appointment for review will be confirmed approximately ten(10) <br /> dayslafter receipt of application. The files will be held for a maximum of five'business days for review. Appointments <br /> sho#be scheduled accordingly_ <br /> 3. A fil that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> subrditted when the file Is available. <br /> 4. Anyle not returned in the same condition as released will be reorganized by EHD staff at the expense 6f the applicant. <br /> Futu a file reviews by the some applicant may require a$105 deposit prior to review. <br /> j FHD USE ONLY <br /> EHD 40-0 8104108 PUBLIC RECORDS RELEASE APP FORM <br /> 1 - <br />