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Sent By: ORSWELL & KASMAN, INC. ; 626 932 1807; Dec-15-09 9:40AM; Page 1 /1 <br /> EHD LOG UlABE <br /> [RIMMIYEO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> WEttr 1 5 2009 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PE /� / ti <br /> APPLICANT: c I �YaCZ ko�,,sk, BUSINESS/AGENCY: <br /> q <br /> ADDRESS: _" w�S I� c\*� j CITY/STATE/ZIP: v,' CA �101 t _ <br /> j t_. <br /> PHONE(1): ( g(, I_` � 1� � <br /> J PHON (2)' _ FACSIMILE: G Z �a=J o •7 <br /> TEIJTATIVE'APPOINTMENT DATE; Time: <br /> (Pleaso allow 10 business days fro t0 of application sdbmIttal-'Tentat/ve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REULIESI -$1 lb FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 DUSIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> tii 5�,No U-/1 I _5 C / <br /> 1. � 302 5 west C r�cr wu y _ `�oc�,,LLo <br /> 2. `d L}L}( wc5� a cY .. Way ac i�lcr, ( iPG p U z <br /> rr J. <br /> 4. JIS.a7l. Ayyv C0VX1 C3 5 �/ 7 Unita 00 <br /> 6. nit <br /> 37 v,Yc <br /> -Ko , <br /> $- [�Unit 5 <br /> 10. ❑Unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HUUSING ABATEMENT ❑SOLID WASTE FACILITYNEIIICLC <br /> OTHER CLEANUP SITE(NON-LOP) ❑FUUU FACILITY ❑WASTE TIRE <br /> UNDERGROUNDTANK(MONITORINGIRF„MOVAL) F1DOG KENNEL [:1DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ElWASTEWATER TREATMENT PLANT —d <br /> � IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPF..R TRUCK/YARD/CHEMICAL TOILETS <br /> TATI`OOIBODY PIERCING ❑POOL/SPA ❑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-5:00l,m(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 /> box(es). At least one file type MUST be selected. Fax to 208 464-0138 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 now 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 /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3426. <br /> EHD USE ONLY ....... <br /> i7-IS��I -. �, T s _.... � I 16�7.1 <br /> 8127/09 <br /> END 48-68 <br />