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08/19/2010 08 34 FAX 8168529--1 Geocon Consultants 16001/001 <br /> DATER V EHD LOG NUMBER <br /> SAN .IOAWUIN COUNTY <br /> OW <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> \any"i` "rNQ� 600 East Main St. Stockton, CA 95202-3029 <br /> _. �G�lephdri (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/5hO7 <br /> pp ��Z�S� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Q7tcw ?JROyjtJ 13U$INESSIAGENCY: C1 Gtr-( Ct�,IS1 1�-rc� <br /> ADDRESS: 7(CQl� �Dt J) /1 , r u ��(L CITY/STATE2IP: &6X_cA0 CA"moO g.CA Q59L41 <br /> PHONE(1):(9l(0� BSS-c{1 ( g PHONE(2):C�d��(OZS-�1(y�S FACSIMILE:CQ(c gS7 -CI( 3 <br /> TENTATIVE*APPOINTMENT DATE: g-2y•fO Time: I "00 <br /> (Please allow 10 business days from data o}applleaUon subMttal-•Tentat/w only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASHHO <br /> OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DAYSSIG ATURE OF APPLICANT �(� ( ii Y_ DATE Pa-(9— (E:> <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street R Street Name city .. 11ntt 1 <br /> OIt_CGoR r S"�fJC�k'i'W-S IVO r/UD LO <br /> 2. 80D Nae�rK c %/7 <br /> �(�•/ S• 23 1 S o,LYF1 .Y SU �1cu4' 75� 40.D oJJ nit3 <br /> r ESI(9/y <br /> 8' nn 4 <br /> T: <br /> e, <br /> (]unit 6 <br /> 9. <br /> 1 sa - s e <br /> 3 'dtlLi+DataReng" }ddile Requested: From to <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACTC4f. , ,1r.N� <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE �iw"IdM, <br /> UNDERGROUND TANK(MONnORINGREMOVAL)9�— ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR a ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT �1.4 <br /> TIERED PERMITTED FACILITYp\ ❑MOTEIIHOTEL PUMPER TRUCK/YARDICHFMICAL TOILETS <br /> IR <br /> ITATTooffivoy PIERCING ❑POOUSPA 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-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(ea). At least one file type MUST be selected. Fax to(209)464-0136 or mall to the address Indicated above Addmss <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 he 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 EMD 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 ae released will be reorganized by EHD staff at th 9YFf the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review, > ..F�� <br /> IND UBE ONLY <br /> 9 <br /> Y- <br /> 3 <br /> RMP• oe O'llle/1 <br />