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05/03/2010 14:57 4085541 AEI SAN JOSE PAGE 01/01 <br /> DATE RECEIVED EHD LOG NUMBSF1 <br /> U IU SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DrzPARTMENT Ida <br /> ENVRONNI,ri'l-r 111-"ALTH' Adr <br /> T�S,-Q 600 East Main St. Stockton, CA 95202-3029 Ar <br /> HER I I ".-'telephone: (209)4683420 Fax: (209)464-0138 Web:www.sjgov.org/ehd &;A <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:- Viol+ BUSINESSIAGENCY: C <br /> 4/7 t) <br /> ADDRESS: �H6 C,>� K <br /> tF;� DM Alk CITYISTATE/ZIP, J 5011 Wnl;e. Lo q92_L <br /> PHONE(1): l Zq PHONE(2), 0 FACSIMILE:1- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow le business days from date of application submittal-*Tenfttive only-must be confirmed) <br /> [:]CHECK BOX TO EXPEDITE REQUEST- 1 FE (C HPR QHEQK ONLY)-REQUEST PROCr.SSI=-D IN 3 61.15INESS DAYS <br /> SIGNATURE OF APPLICANT DATE LJ D <br /> Electronic Information: [] List[]Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street ft St,",Name City Unit 1 <br /> TG a-LVD . TM'\/ Iu� X51 <br /> 6\1 FR; VD, 0 Unit 2 <br /> -4H <br /> 23 W (12A QNE FT --2 <br /> 4. <br /> 5. kUnI0 <br /> 6. <br /> — Unit 4 �t <br /> 7.8. <br /> —*i <br /> El Unit 5 <br /> 9. <br /> 10. <br /> 0 unit 6 <br /> Specffic Date Range of information Requested: From to <br /> ENVIRONMENTAL HE AR ENT FILES <br /> �1NDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ,STHEP CLEANUP SITE(NON-LOP) Q FOOD FACILITY Ej WASTE TIRE <br /> — NDERGROUND TANK(MONFTORING/REMOVAL)O( El DOG KENNEL [I DAIRY Uf <br /> MAZARDOUS WASTE GENERATOR [--]CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT I 0/10 <br /> TIERED PERMITTED FACILrrYV1 L]MOTELMOTEL El PUMPER TRUCKNARNCHENCAL TOILETS <br /> ATTOOIBODY PIERCING �POOUSPA [:1 LAND USE APPLICA71ON STIES0 MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)&I V)q V0ZWMy1e14*P <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MoNiDAY-FRIDAY 8:00 AM-5-00pm jEXCLUDING Hoi.IoAys) <br /> 1. List u12 12 ten addresses in the space above. Select the type(6)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax 19(2091_464.013$ or Milli to the address lndIrgfSd AND-ye. 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 SHO files exist. An appointment for review will he confirmed approximately ten(10) <br /> days after receipt of application. The files will be hold for a maximum of five business days for review, Appointments <br /> should be scheduled accordingly. <br /> 3. A file that 19 actively being worked on by END 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 IEHD 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 /> q71D END USE ONLY <br /> T/A Lu I j';-r 'L 1,5 A- <br /> ce� <br /> END 0-00 <br /> 9127109 <br />