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12/22/2009 15: 05 9155645444 LEWIS BRISBOIS ET� PAGE 02/02 <br /> EHD LOG NUMBER <br /> VV�I IVri JESAN JOAQUIN COUNTY <br /> V <br /> � D ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> V` 4 L Z ZOO-Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orqd <br /> ENVIRONMt'-Pj1 HE �jPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Lyw�i :�p�uNol'c�j�4M D tsM 13NUSINES$IAGrENCY: <br /> ADDRESS: 28"50 CTAOf A�S 172 , =9 950 CITYISTATEIZIP:�.5ACkA MEAT m�C' 4 �TS�� <br /> PHONE(1): 716-(q6-ff j&i PHONE(2): FACSIMILE: 56 y- 5YYy <br /> TENTATIVE'APPOINTMENT DATE: Q 1�(p a0 f 0 Time: 9= 30 <br /> (Please allow tel baseness days from data of applepll at bmnot--Tontative only.must ba cunfIrmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST SS115 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> rstreet It Street Name City Unit 1 <br /> 2. ❑Una2 \ <br /> 3. <br /> 4. nit �\\\ <br /> 6. Unit 4 <br /> 7 <br /> B. - -� - - - — E3Unit 5 <br /> 9. <br /> 10. ❑unite <br /> specific barn Range of information Requested: From 2to T <br /> ENVIRONMENTAL H LT DEPARTMENT FILES <br /> Ipi UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILTTYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> ®UNDERGROUND TANK(MONnORINWREMDVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILRY ❑MOTELMOTEL ❑PUMPER TRUCKIYARNCHEMICAL TOILETS <br /> ❑TATTO0IBODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM�5:OOPM(EXCLUDING HOLIDAY$) <br /> 1. List Up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax 10(2091464-0138 or-mg1l 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 busineas day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately tan(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$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)468.3425. <br /> Elie USE ONLY <br /> EHD 4?e6 812110? <br />