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I-22-2009 10:46 From: To:12094640138 Pase:1,11 <br /> 0 0 <br /> I17(1;07mr_OLU), SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> jLjN 2 2 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EN <br /> IVIRONI-JENT HEALTH <br /> PE !T/SERV!CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _WCfn!e_ L-0--"dy-si BUSINESSIAGENCY: <br /> ADDRESS: L g- a'f--) , City/Stato/Zip LA PaL.Pt�1f„p � <br /> PHONE(1): �_) . PHONE(2): —FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Q0 I S �3 Time; 0 <br /> (Please allow 10 business days from date of application submittal-'Tdn1adV@ only-must ba confirms lesi <br /> I]?'CHECK BOX TO EXPEDITE REQUEST-$106 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSZ104 A <br /> SIGNATURE OF APPLICANT �:&LU L,2 ,nC&'L4 DATE 7-/n9 <br /> Electronic Information: Fj List[I map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> -A) Unit I <br /> o a—+C)r) <br /> 2. �j q L4�7 <br /> () )+I--- + <br /> 4, 41T,Unit 3 <br /> A'pt, <br /> Unit 4 <br /> 6. <br /> 7. <br /> Units <br /> 8. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From LV2 C-2 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> m-6NDERGROUNo TANK(UST)CLEANUP SITE(LOP) 0 HOuSiNGASAYFMCNY 0 SOLID WASTE FACILITTAIEHICLE <br /> Ca"OTHCR CLEANUP SITE(NOWLQP) 0 FOOD FACILITY 0 WASTE V12 <br /> M"UNDERGROUND TANK(MOUTORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY cop 4(®f <br /> M'AA7-ARDOUS WASTE OENERATOR K C3 CHICKEN RANCH CI WASTEWATER TREATMENT PLANT <br /> 171 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCKrYARD/ql <br /> _ (liifp!)En <br /> 0 TATTOO/BODY PIERCING 0 POOUSPA 0 LAND USE APPLICAT10""O'gi <br /> MEDICAL WASTE <br /> 0 OTHER(PLEASE SPECIFY) <br /> C3 FAGILITY 4 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA$tA FOR REVIEW- MQNOAY-FRIOAY8:00 Am-5:00pm -EnLIJOING HOUP 4'`' C <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropr <br /> box(es). At least one file type MUST be selected. Fax to(209)41114-0138 or mail to the address indicated above. Addres <br /> ranges will not be accepted—for additional assistance with filo addresses,contact the EHD. Applications received after5 <br /> 100 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 ton(10) <br /> days after receipt of application. The files will bo hold for a maximum of fiva 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 /> 0/_7qjq tj'. q V-4 A,71M_t _kA)(lip_ I-D A)F. 62? 7 qll)q <br /> A V . Aoeu Lf, E�6_ <br /> L&.4ef h4l a LA) A) <br /> _eo, 10 d1,1 A I' -1,d 2") <br /> r(2 di <br /> aWN -A r 0) CA0230 l[AC0 3012qLj <br /> f, A-J r 6!K0S. <br /> EMD 48-08 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />