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NOO-22-2009 15:23 ARCADIS BRIGHTON MI 810 229 8837 P.02i02 <br /> EHD LOG NUMBER <br /> rmn- 1 jj� �i- SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2009 600 East Main St. Stockton, CA 95202-3029 <br /> T.0I phone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/i6 <br /> ENV1R�)WV'!d\4 i_HFAU a 51 <br /> NFgN11T1SLg jraLS PUBLIC RECORDS RELEASE APPLICATION 6 <br /> APPLICANT: nN&4,jjf 6 j)IWIA-4 BUSINESSIAGENCY; code 6r1Vi rQr)11y"t.t</ <br /> ADDRESS: Dc. StL;4-e_jt0() CITYISTATEIZIP: fr` hf0n S <br /> PHONE(1): PHONE(2): --"`'-' FACSIMILE: S 1 w4 - 3 <br /> TENTATIVE*APPOINTMENT DATE: IA 1;11 17&0( &4;a - car, fcdr>+_ Time:_- <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 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 EHD USE ONLY <br /> Street# W - — Street Name city ------------runit 1 <br /> 1. Z 2 San - <br /> 2. ❑ Unit 2 \ <br /> 3. <br /> 4. <br /> 5. <br /> 6. /Unit4 <br /> 7. <br /> _. .._..,._ p units <br /> 10. /ulit!j <br /> Specific Date Range of Informatlon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) �HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑Fool)FACILITY WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR L]CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LF FOR REvim MONDAY-FRIDAY 8:00 AM-5:00RM(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 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 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 now 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 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 /> END USE ONLY <br /> EHO 46-06 8127109 <br /> TOTAL P.02 <br />