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03/02/2011 12:05 FAX la001/001 <br /> ZHD LOG NUMBER <br /> R EL) SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 0 2 2011 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax. (209)464-0938 Web: wvvw.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P- <br /> APPLICANT:_ftyj!�- jEiWA ?A)C' BUSINESSIAGENCY., eP9 <br /> ADDRESS: _ `.i%Li ImAEror�t k4cCITYISTATE/Z1P: &AC_ZAtKe4b tcA 958T_( <br /> PHONE(1): (4(6� � -�2' � PHONE(2); 'q( b%-Iq-219 FACSIMILE:61(6)44W—C*a T <br /> TENTATIVE"APPOINTMENT DATE: 'Gime: <br /> (Please allow 10 business days from dale of appllcatlon submittal-"Tanfadvo only-must be confirmed) <br /> ❑CHECK 13OX TO EXPEDITE REQUES . $122 FE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z 'Zo <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Street p Stre$t Name Clty ❑Unk 1 <br /> 1" ' Zaoo... S ~(45T-" kAt'l," 4TVC-IC <br /> ,2. 4 L&Ac— Tax ❑Unit <br /> 3. 7100 C_fi'IL,.0,41C <br /> 4. 2' 1 b S'tSW0.Q-T SCAStI-17 %T& I-1< unit a <br /> S. 2." 17- 1r.rtVwAa¢q-- S'T1t42r—r S-t arc,k_-m A95!] <br /> 6. Unit 4 )0 <br /> T <br /> 9 <br /> 10. [1 unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH:DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING AIIATEMENT ❑SOLID WASTE FACiLITYIVENICLE <br /> OTHER CLEANUP SrrE(NON-LOP) ❑FOOO FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MoNITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑Timm PrRMrrTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRl1CKNARDICHEMICAI TOILETS <br /> ❑TATTOOIHODY PIERCING ❑POOLISPA ❑LANn ItSE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MOND"-FRIDAY 8:00 AM-5:00PM(EXCLUDINo HOLIDAYS <br /> i. List un to tan addresses in the apace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At feast one file type MUST be selected. Fax to(209)464-01;j or mall to the addn�ss_indlcated 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 bu$Iness day. <br /> 2. The END 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 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 Imilledlately available for review. A new appllcatlon may be <br /> submitted when the file is available. <br /> a. Any file not returned In the same condition as rele"ed will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to revlew. <br /> EHO vee oras <br /> UHR 44 07l28N4 <br />