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05/03/20101l`14:57 4085597 AEI SAN JOSE PAGE 01/01 <br /> RECEu U E <br /> DATE RECEIVED, EHD LOG NUMHE <br /> INu 3 �11i0 SAN JOAQUIN COUNTY <br /> Ic: is <br /> HEALTH <br /> ENTA <br /> ENVIRONMENT i-�EA1,14- �N pip EastMMain St. Stockton, CADS 20-3029NT <br /> pEWT,'SE-PN"Ulephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ I of BUSINESS/AGENCY: 1 ca/IW 1/1 6 SADDRESS: CITIISTATE7P: o ]I�S <br /> Z( <br /> PHONE(2): 0 -Te Q FACSIMILE: fDPHONE <br /> C7 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please an"10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- sFE (CA§H�j R CHE K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Y i T 1�✓l _ DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street R Street Name City ❑unit 1 <br /> 1. bra � G L�D . <br /> 2. 342 N BUD. ❑Und2 <br /> 3. 23. W <br /> 4. Unit 3 <br /> 5. <br /> 6. Unit4 �1 <br /> 7. <br /> 8• p units <br /> 9. <br /> 10. Ll unit e <br /> SpeclHc Date Range of Information Requested: Fromto <br /> ENVIRONMENTAL HEALTH AR ENT FILES <br /> �KVNDERGROUND TANK(UST)CLEANUP SITE(LOP) [I HOUSING ABATEMENT ❑SOLID WASTE FACIUTYIVEHICLE <br /> .OTHER CLEANUP SITE(NON-LOP) El FOOD FACILDY E]WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) El DUG KENNEL [I DAIRY <br /> fflnjA <br /> A2ARDOUS WASTE GENERATOR ElCHICKEN RANCH ElWASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTEUHOTEL [IPUMPER TRUCKNARD)CHERCALTOILETS <br /> TTOOIBODY PIERCING POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)QI1/1�V02 PMyeW-e.D <br /> WELL AND SEPTIC PERMIT RECORDS ARE,AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Am-S:0DPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(a)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(20 1484.0138 or mall to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received atter <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 retumed 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. H you need further assistance,please contact Diane Martinez,at(209)488-3425. <br /> EHD USE ONLY <br /> EHe ae-06 6!27109 <br />