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05/26/2011 THU 14: 02 FAX 20c' 12999 SJC Public Works 0002/002 <br /> RECEIVED <br /> DATE RECEIVED <br /> SAN aIOAQUIN COUNTY EHD LOG NUMBER <br /> MAY 2 6 2011 ENVIRONMENTAL HEALTH DEPARTMENT n6q, <br /> 600 East Main Street, Stockton, CA 95202-3029 OPWW <br /> ENVIRONMENTAL HEALTIflelephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION (� <br /> APPLICANT: 0. IL BUSINESSIAGENCY: S l� r0l I rki� <br /> ADDRESS: 1•g I Z ( �� AVC_ City/State/Zip S cx fog Cf� Z'1 Z0 <br /> PHONE(1): ���Y�o�Z �Sr PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'rentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST.$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S �6 <br /> i <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> - -- Unit 1 <br /> 1 Al S#Z _ .�1 o.ti 4C_4� <br /> 2. #, o 6 1\_ ( ( Unit 2 <br /> S o / <br /> Unit 3 <br /> 4. <br /> Unit4 <br /> 6. l L l l f <br /> TUnit 5 <br /> 8. �l 6 1{ I l ( t <br /> 9. t L < t �/�nit 6 <br /> f10. t t I,k I 5 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ZZHOUSING ABATEMENT SOLID WASTE FACILITYfVEHICLE <br /> IKhrO, THER CLEANUP SITE(NON-LOP) 5tFOOD FACILITY WASTE TIRE <br /> %UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> WHAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH D WASTEWATER TREATMENT PLANT <br /> ill TIERED PERMITTED FACILITY R MOTELIHOTEL IS PUMPER TRUCKIYARD/CHEM TOILETS <br /> C3 TATTOOIBODY PIERCING ❑POOL/SPA PLAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-S:OOPM -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 /> boxes). 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 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />