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04/27/2009 16:16 FAX 916 817 4747 H D R ENGINEERING �Q41 <br /> E <br /> COD :Do <br /> 4w) t..0) EHD LOG NUMBER <br /> RataODS SAN JOAQUIN COUNTY <br /> APS{ 21 2409 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRO N7 HEA1�e ephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgo <br /> PERmg <br /> SPRVtCES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCAf& � ter-S�Tt VVI - BUSINESS/AGENCY: <br /> ADDRESS llz©N pC>jNT -- {�i . I caylStatgZlp b t- 30 Mr C _ -1 <br /> PHONE(1 -%-7- PHONE(2): FACSIMILE: 110-9 <br /> TENTATIVE*APPOINTMENT DATE:, —,::-/a loci Time: <br /> (please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> 0,CHECK BOX TO EXPEDITE REQUEST-$105 FEE(GASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATIRE OF APPLICANT DATE <br /> Electro Ic Information: ❑1_Ist-Q Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> treat it Street Name City ❑ Unit 1 <br /> tv. 4 Hey `9'1 <br /> 2. dr`�4-� ttil. �+ `)`1 5i-o�­1 <br /> knit 2 . <br /> 3. 4o2a1 N I-) Unit <br /> S-t-a G�-�r o��} <br /> 3 <br /> 4. q C>1 N, 3 i W e)l <br /> b• q-7b fel� HW 1i9 -I I \ <br /> 3 Unto <br /> 7. ❑ Unit 5 <br /> 9, ❑ Unit 5 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4JtiilmlROUND TANK(UST)CLEANUP SITE(LOP) M}LOUSING ABATEMENT 13 SOLID WASTE FACILTrYIVEHICLE <br /> L-I OTHER kLEANUP SITE(NON-LOP) Q FOOD FACILny Cl WASTE TIRE <br /> JINDER6RooNDTANK(MONrrORwGIREMOVAL) 13 DOG KENNEL ❑DAIRY <br /> ❑HA7AR OUS WASTE GENIrRATOR 0 CHICKEN RANCH 173 WASTEWATER TREATMENT PLANT <br /> 0 TIERED emiTTED FACILITY 13 MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILM <br /> ©TA TT ODY PIERCING G POOL/SPA 0 LAND USE APPLICATION SITES <br /> L7 MEDic WASTE FActUTY 0 OTHER(PLEASE SPECIFY) <br /> ij WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS- <br /> 1. List t p to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box( s). At least one flle type MUST he selected. Fax to(209)'454-0138 or mail to the address indicated above. Address <br /> rang s will not be accepted–for additional assistance with file addresses,contact the 5HD. Applications received after <br /> 3:00 m will be processed the next business day. <br /> 2. The qHD will notify the applicant if any END 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 reAew. Appointments <br /> shogd he scheduled accordingly- <br /> 3. A fii that is actively being worked on by END staff may not be immediately available for revlew. A new application may be <br /> subrAitted 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 of the applicant. <br /> Futu a file reviews by the same applicant may require a$105 deposit prior to review. <br /> y EHD USE ONLY <br /> i I <br /> r <br /> EHD 4-041 8144108 PUBLIC RECORDS RELEASE APP FORM <br /> i <br />