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1_0/25/2010 16:05 FAX 209 946 5730 CALIF RURAL LEGAL ASSIST Z002 <br /> �� � _ !! �x <br /> �� I] EHD LOG NUMBER <br /> +�'I�� ' � �—' SAN JOAQUIN COUNTY <br /> II1010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> X41 I , , ;,_ <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> C-ita`Lehone: (209)468-3420 Fax: (209)464-0138 Web:wwvy.sjgoV.org/eh@ <br /> IITISERVICES .-- --PUBLIC-RECORDS-RELEASE-AP-P-LOCATION- -- .-------------- --- <br /> APPLICANT: E <br /> ulrtrMlS BUSINESSIAGNCY: C=A1Z v1(0� <br /> J Asi4m<A <br /> ADDRESS: 1,4�5 E', Wf_1P,_e A�?e. — CITY/STAT IE=MP: L4 q5 Z. <br /> PHONE(1): 'g4�-0409 PHONE(2); �OlodSF� CSMIL!<:_ 2d�- 944'S73C? <br /> TENTAT/VE"APPOINTMENT DATE: li Time: T <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_IL �'7-�r �.��_....._._.__... I� DATE /0 L S <br /> Electronic Infortnation: ❑ List[]Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city II ❑Unit t <br /> 5 0 1 S. E i I>GrgtJ o S fi'�}- Ca j <br /> 2. .I <br /> ntt 2 <br /> a. Unit 3 <br /> 5. i ❑ \\ I <br /> ©Unit4 I <br /> 7. I <br /> 8. <br /> — 9. <br /> 10.Speclflc Date Range of Information Requested: From .a til h� 1 'Z,.0` I1 fo n f-ft" r-;;Uij <br /> I <br /> ENVIRONMENTAL HEALTH DEP ENT FILES <br /> ❑UNDERGROUND TANK(LIST)CLEANUP SRE(LOP) HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY I'I ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL I! El DAIRY <br /> ❑HAZAwous WASTE GENERATOR ❑CHICKEN RANCH i� ❑WASTEWATER TREATMENT PLANT <br /> -' ❑TIERED PERMITTED FACILITY ❑MOTELJHOTEL I' ❑PUMPER TRUGKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA I� ❑LAND USE APPLICATION SITES <br /> I� ❑ MEDICALWASTE FACILITY 151 OTHER(PLEASE SPECIM AKy fi'k K„j4t" fu G4p44C,/Scwer4vu%vwn�~ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(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. . ax to209 464-0138 or ail 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. it <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. I <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 avallable. <br /> I <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD. taff at the.expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHD USE ONLY �! <br /> �I <br /> li I <br /> I! <br /> II 'r <br /> EHD"-a6 f <br /> 07!28110 <br />