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U6/6jiUV LU;40euz - Nass ana Nass Law u L10es bbus/9u7bu p.pl <br /> (D� r EDEHD LOG NUMBER <br /> D v SAN JOAQUIN COUNTY �"� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> hE$ 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgo e <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PER n mseR as <br /> APPLICANT: Mi r h g P] n g l A cg-Zn' Brad l P 7 K a fi a BUSINESSIAGENCY: Kass & Kass L a w Offices <br /> ADDRESS: 520 S. E1 Camino Real , Ste. 810 City/State/Zip San Mateo, CA 94402 <br /> PHONE(1): (650) 579-0612 PHONE(2): (650) 766-1247(Mike ACSIMILE: (650)579-0760 <br /> TENTATIVE*APPOINTMENT DATE: as soon as possible Time: <br /> (Please allow 10 business days from date of application submittal-'rentattve only-must be confirmed) <br /> D CHECK BOX TO EXPEDITE REQU $105 FEE H OZCL Y)- EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2/23/09 <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> Unit 1 <br /> F.21 <br /> 19256 N. State Route99 rnt Acam o n:5 Q2 42 Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5. unit <br /> 6. <br /> 7. <br /> ❑ Unit b <br /> 8. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From _01/01/08 to present <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -M UNDEROROUND TANK(UST)CLEANUP SITE(LOP) 17 HOUSING ABATEMENT Q SOLID WASTE FAcmTY/YEHICLE <br /> IM OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY CI WASTE TIRE <br /> M UNDERGROUND TANK(MomTORING/REMOVAL) ❑DOG KENNEL [I DAIRY <br /> M HAzARvous WASTE GENERATOR ❑CHICKEN RANCH CI WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY Q MOTELIHOTEL iD PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING O POOLJSPA 23 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY IR OTHER(PLEASE SPECIFY) l e a k <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:00PM - ExcLUD(NG HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the t)pes)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address 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 retumed 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />