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11/30/2009 13:52 50992P"15 URS PAGE 01/01 <br /> G-� �GA f7�D END LOG NUMBER <br /> )�y 1FjJ',�fl D SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 3 0 2009 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone; (209)468-3420 Fax: (209)464-0138 Web: www-sjgoy.org <br /> EIdNONMENTPZF_8M jsFR HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �;,+BiAm �USINESSIAGENCY: ups �_0, � <br /> ADDRESS: /✓, `2 S � CITY/STATEIZIP: - ISLE ,/wi4/q.9 0/ <br /> PHON j1)' 509-1CZp1g—y j 3 PHONE(2): $T)`j 9 V`/-380-4 FACSIMILE: .$ q— a� L P_yylJ <br /> r TENTATWE'APPOINTME=NT DATE: Time; <br /> �a (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> CHECK DOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> • nay � <br /> Electronic Information-, ❑List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name GtY _ Unit 1 <br /> 2• (257/q {pa c r 'C . Unit 2 <br /> 3. x.973 o40ALi:64 . a. 04- <br /> 4. Unit 3 <br /> 5. <br /> 7. <br /> Unit 6/ <br /> Specific Date Range of Information Requested: From 1950 to pudt-k-- V_i <br /> l~NVIRONM rNjAL HEALTH DEPARTMENT FILES � <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT OLID WASTE FACfLITY1VEHICLE p Q'jo�"'Qv <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUNI)TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIV <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTEE FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATT00180DY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5.00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)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 Ind rated 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 returned in the same condltion 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 /> M)USE ONLY <br /> EHD 48-08 8127/09 <br />