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04/27/2009 16:16 FAX 9I6 817 474 H D R ENGINEERING Sj00i z <br /> �ED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 'PR 2j7 Z0Q9 ENVIRONMENTAL HEALTH DEPARTMENT <br /> HEAe'lep600 East Main Street, Stockton, CA 95202-3029 <br /> EN E Dl� E qz 7 <br /> � �vt� hone: (209)468-3420 Fax. (209) 464-0138 Web: WWW.Sjgo <br /> P <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIC : VOM BUSINESSlAGENCY: Hb3 _ <br /> ApI1RE35 2-36� l�-4�] l it " {��_ _,1 � _ , City/Statomp L_Sq", <br /> PHONE(1 �`�D'SII �� -- PHONE(2}: `FACSIMILE: <br /> TENTATIVE*APPOIITfMENT DATE: 15 S 0G Time: <br /> (please allow 10 business days from date of application submittal-'rentadva only-must be eonflrmed) <br /> d CHECK BOX TO EXPEDITE RF-QUEST•$105 FFE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 81ISINESS DAYS <br /> SIGNATPRE OF APPLICANT DATE <br /> Electro Io Information: L] List'[]Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> trent# street Name City Unit i <br /> �. 73 IQ- V+Wy 21 � <br /> 2. 4— hj, Hid `�l`� ��+oG �� `�G�`2� unit . <br /> 3. 1�,�� N• �l -ry G1Gi�c\l 7 unit 3 <br /> a. q, s✓1 �}, �v "1`) ro �xaJ <br /> N\V, <br /> �1 b3 Unit 4 <br /> 6. <br /> 7. Unit 5 <br /> J, Q Unit6 <br /> Specific date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1 I'"INDER ROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING AeATEM£NT D SOLID WASTE FACILtTYIVEHICLE, <br /> OTNER�LEANUP$nE(NON-LOP) tl Fpoo FACWTY 0 Wm TE TjRE <br /> 1NDERiROUNDTANK(MONnToRING1REINOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZAR i DUS WASTE GENERATOR ❑CHICKEN RANCH ❑WA3TEwATER TREATMENT PLANT � <br /> ❑T]ERED ERNIMM0 FACILMY l7 MOTxLJIAarEL ❑PUMPER TRuCK1YARDICHEM TOILETS <br /> Q TA ODY PIERCING 0 POOLISPA 13 LAND USE APPLICATION SITES <br /> ❑MEDlc WASE FACILITY a QTKER(PLEASE SPECIFY) <br /> q WELL AND SEPTIC PERMIT RECORDS ARE AvAILAeLE FOR REvIEw -MONDAY-FRIDAY 8.00 AM-5:OOPM - EXcLUDING HOLIDAYS. <br /> 'l_ Listp 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 file type MUST be selected. Fax to(209)'464-0138 or mail 10 the address indicated above. Address <br /> rang S will not be accepted—for additional assistance with file addresses,contact the i`HD. Applications received after <br /> 3:00 m will be processed the next business day. <br /> �i <br /> 2. The qHD 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 /> shoo d be scheduled accordingly_ <br /> 3. A fil that is actively being worked on by END staff may not be immediately available for review. A new application may be <br /> sub itted when the file is available. <br /> 4. Any le not returned in the sante 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 /> 3 EHD USE ONLY <br /> i <br /> FHD48.0 8104108 W PUBLIC RC-CORDS RELEASE APP FORM <br />