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07/15/2010 12:57 FAX 1707X' '14 ERI Petaluma Z001/002 <br /> FD,(r� MD <br /> EHD LOG NUMBER <br /> —���� _ SAN JOAQUIN COUNTY <br /> u ENVIRONMENTAL HEALTH DEPARTMENT <br /> j';� / 600 East Main St. Stockton, CA 95202-3029 <br /> \ `I� j i I_,[,ojelephone; (209)468-3420 Fax: (209)464-0138 Web; www.sjgov.org/ehd <br /> PER , l Py'1F Fs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:--To til 6 p���. � Zoe BUSINESS/AGENCY; E~NV tR�N t'�+<F-rSC�I. ��oLa�TZo t�S <br /> ADDRESS: &)OWE QL`rn CITY/STATE/ZIP: P614V- A <br /> PHONE(1): 0 PHONE(2): �� go4 q FACSIMILE: P-j , 729 <br /> TENTATIVE"APPOINTMENT DATE: 71 a C Time: <br /> (Please allow 10 business days from data of application submittal.•Tentsflvs only-must be Confirmed) <br /> CHECK BOX TO EXPEDITE RE T•$115 FEE(CASH-OR CRrCK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT !7 9 DATE �. LS. ?,aLD <br /> Electronic Information; ❑ List n Map—Description: <br /> FILE ADDRESS Elio USE ONLY <br /> Street II Street Nemo city <br /> �0 /Z ❑Unit 1 <br /> 3. <br /> 4. <br /> 6. •� _ nit 3. ` •'. <br /> 7. L GHQ — El Unit4 <br /> V <br /> 8.9. 00 e �,1 LYS ---- ❑Unit 6 <br /> Unit 8 <br /> Specific Dote Range of Information Requested: From 1 �O <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILiTYNEHICLE /i <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVALO� ❑DOG KENNEL ❑DAIRY _ <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH El WASTEWATER TREATMENT PLANT <br /> El TIERED PERMITTED FACILITYk y ❑MOTEUHOTELN <br /> ©PUMPER TRUCK/YARD/CHEMICAL TOILET$ <br /> ❑TATTOOIBODY PIERCING POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) ' � � OlL X f kLL. <br /> WELL ANO$EPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u o ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(ee). At least one file type MUST be @elected. Eax to 12491464.0198 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 after <br /> 3:00 pm will be prooaeaed the next business day. <br /> 2. The EHD will notify the applicant If any EHQ files exist, An appointment for review will be 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 Is actively being worked on by FHG 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 $115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(208)468-3426. <br /> 01 ENh USE ONLY <br /> t C - - <br /> D -08 <br /> 8121109 <br />