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AUG-118y-2010 15:52 Tetra Tech, Inc. 415 974 5914 P.01i01 <br /> DATt L j) SAN JOAQUIN COUNTY <br /> —'�`I V/ ENVVONMENTAL HEALTH DEPARTMEe <br /> AUGcU10 600 East Main St. Stockton, CA 95202-3029 <br /> ENV1Humv;tT09P,PgIfN(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 5 <br /> PER MIT/SERWCf$UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ,rP sr- BUSINESSIAGENCY: 111-4 Te'Al <br /> ADDRESS: S51 fJl6A4 4 1Sk" Ry, CITY/STATE/ZIP: J_C-A 9q 0T <br /> PHONE(1): q1T q lel-IZZI PHONE(2): FACSIMILE: qIS• 4-1u- S'rltu <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-*Tentative only.must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST.$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> �. iNaoo k NO ... , 12,.. - � Vii.. e"' <br /> 2. Unit 2 <br /> 3. <br /> 4, <br /> S. <br /> 0, CWhit 4 <br /> 7. <br /> $, :Unit 59. <br /> 10• nit 6 <br /> Specific Date Range of Information RequeSted: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILiTYNEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIPEMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELMOTELUMPER TRUCKIYARWCHEMICAL TOILETS <br /> []TATTOO/BODY PIERCING ❑POOtISPA to LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) ISAI Y I�tAPI A&% <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Review: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo 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 r 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 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 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 condition as released will be reorganized by EHL)staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> END USE ONLY <br /> -11 <br /> w r- F O <br /> beClis r,0A <br /> 0»129110 <br /> EHD 48.08 <br /> TOTAL P.01 <br />