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_09/25/2007 08:51 FAX 5307585672 FEDGX KINKO'S DAUIS U002/003 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjgov.o I (113 <br /> t� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> T)-- rtil\S/ - W 65te a I` BUSINESSIAGENCY: <br /> ADDRESS: //6 YAIIC(�CLQ Nut- —_DGt11�S, C/f 9SG�6"Z7/E�� lU <br /> PHONE )758`83�3 PHONE(2): (536) 902'0632 FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirm <br /> CHECK BOX TO EXPEDITER QUEST-E98.00 FEE(CAS �IDNLYIREQUEST PROCESSED IN 3 SftAH <br /> NATURE OF APPLICANT DATE Z <br /> i. <br /> Electronic Information: ❑ List El Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streot 0 Street Name city ❑ Unit 1 <br /> 1708 E A(Pr,P_ nava Rd Lod ' Z-1 <br /> t <br /> z. 9 0 N �e f� '°� Lod I' nJo �, " �� I�' i< �, <br /> N. �-- .a <br /> 3.' 2 N.n o r nfor` R00A 906 <br /> ❑ Umt3 <br /> 4., <br /> II W. Sa(-ems='Rodq5--Oc/ - - <br /> ❑ Unit 4 <br /> 6V A�, q 1 �. �2;r 5+2e.�or 12rC e_e}GCL /UO L3 <br /> ' Lo�1 i /ll <br /> L7. r I Ram 8d 0 ❑ units <br /> 5 t 6,z r{��,:. i q [ G_<. vP 99-aq q9 oil,92,2z,q1S�+al-SU. <br /> 1 12_Ir /-o t ra It-e(4r rri5 910-'��' ❑ Unit6 <br /> E �� �O�cL 0/9 1_od.i An,6 92-09 AA 9?—.Sy <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACI <br /> OTHER CLEANUP SITE(NON-LOP) 171 F000 FA ILITY M WASTE TIRE SH <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) C3 D K EL DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR NCH 13 WASTEWATER TREA ENT LANT <br /> •TIERED PERMITTED FACILITY EL 13 PUMPER TRUCKIYARD/CHEM TOILETS <br /> •TATTOOMODY PIERCING PTHER <br /> AND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ASESPECIFY) <br /> WELL AND SEPTIC PERMITO VAAvAILA8LE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-S:IXIPM -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(2091464.0138 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 /> h ouldbes chedule d-Accnrding Ly- <br /> s. A file that is actively being worked on by EHD staff may not be immediately available for review. A new app Icat on may e— -- <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$98.00 deposit prior to review. <br /> END USE ONLY <br /> EHD 46-09 WEB aWM7 <br />