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02/12/2009 00:09 FAX 9163722565 IyALLACE-KUHL AND ASSOC. <br />• 001 <br />(��-DATE RECEIVED <br />__ _ <br />MD�U S SAN JOAQUIN COUNTY EHD LOG NUMBER <br />Il tl ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />FEB 12 2009 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.r d� <br />ENVIALTH <br />PEPA4; EW4CPUBLIC RECORDS RELEASE APPLICATION <br />41 <br />2, �3 <br />APPLICANT: (jGN 61°LEkA/On/ BUSINESS/AGENCY: CV#L-I-A-GL - %CU/4L d Arr. <br />ADDRESS: p32 -SI BEAc4N MIVC> City/State/zip JEST' SAy(2,Fl I+�tEN'1rD/� <br />PHONE (1): !I(, - 37 7- - IL4-3>4 PHONEG <br />E((2): FACSIMILE: 1I6 37'. 2S (05 <br />TENTATIVE` APPOINTMENT DATE: .2 - I B 'O 9 Time: Cl-' 00 A-" <br />(Please allow 10 business days from date of application submittal -`Tentative only -must be confirmed) <br />CHECK BOX TO EXPEDIT R UES7 - $7 FEE OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE o7' /,P- -0 % <br />Electronic Information: ❑ List ❑ Map - Description: <br />1. <br />-2' <br />to P. I.;L - e el <br />FILE ADDRESS <br />Street Name City <br />--G6AP_A-1, L.LOW <br />�r0L4Y pl21VI9 A-CY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />Street# <br />g Z <br />zOSab <br />EHD USE ONLY <br />Unit <br />5102 Ey ,, tU1/5 2 <br />3. <br />❑ $OLID WASTE FACILITYIVEHICLE <br />71 WASTE TIREI� <br />f(]' <br />• ��✓ �� <br />4. <br />11 DOG KENNEL <br />- <br />- Unit.3i <br />5. <br />❑ CHICKEN RANCH <br />❑ MOTEL/HOTEL <br />❑ WASTEWATER TREATMENT PLANT <br />6. <br />13 TATTOO/BODY PIERCING <br />MEDICAL WASTE FACILITY <br />_. .. _ —. <br />nit4.. <br />7. <br />❑ OTHER (PLEASE SPECIFY) <br />8. <br />❑ Units <br />9. <br />❑ Unit 6 <br />10, <br />Specific Date Range of Information Requested: <br />From <br />to P. I.;L - e el <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />FILES <br />�,� <br />� U ERGROUND TANK (UST) CLEANUP SITE (LOP) <br />HER CLEANUP (NON•LOP) <br />❑ HOUSING ABATEMENT <br />❑FOOD FACILITY <br />❑ $OLID WASTE FACILITYIVEHICLE <br />71 WASTE TIREI� <br />f(]' <br />• ��✓ �� <br />666 NO ERGROUND TANK(MONITORING/REMOVAL)CL <br />• HAZARDOUS WASTE GENERATOR Q� <br />11 DOG KENNEL <br />❑DAIRY <br />I <br />• TIERED PERMITTED FACILITYpK <br />❑ CHICKEN RANCH <br />❑ MOTEL/HOTEL <br />❑ WASTEWATER TREATMENT PLANT <br />/ <br />13 TATTOO/BODY PIERCING <br />MEDICAL WASTE FACILITY <br />❑ POODSPA <br />❑ PUMPER TRUCKIYARD/CHEM TOILETS <br />❑ LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:G0PM -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 (209) 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 fora 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 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 $105 deposit prior to review. <br />EHD USE ONLY <br />EHD 46-06 8/04/08 <br />UULIi KtUUttuS HELLASE APP FORM <br />