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Sent By: ORSINELL & KASMAN, INC.- ; 626 932 1807; Dec -15-n9 9:40AM; <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />ULLL 1 5 2009 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0136 Web: vwv V.Sj90V,org/e <br />ENVIRONMENT HEAL1IPC0 PUBLIC RECORDS RELEASE APPLICATION <br />ot-onelrlecoulrcQ <br />Page 1/1 <br />EHD LOG WADE <br />APPLICANT:_� i `Y9G�' ���t__- BUSINESS/AGENCY: <br />ADDRESS. 3 w cS ,„ � �n c'ur Ll CITYISTATE/ZIP: vi' _CA i M� t; <br />PHONE (1): fig(, ��2 - 19Z PHON {2)' F FACSIMILE: (' 3a I $0 7 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 buaineas days fro to of application Slibmittal - •Tenfadve only - must be confirmed) <br />CHECK BOX TO EXPEDITE RERUES I - $115 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 OUSIN SS DAYS <br />SIGNATURE OF APPLICANT DATE.- <br />Electronic <br />ATErElectronic Information: ❑ List ❑ Map - Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES n �� <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ElSOLID WASTF. FACILITYNEIIICLI! <br />OTHER CLEANUP SITE (NDN -LOP) ❑ FOOD FACILITY F1WASTE TIRE [6 ' �A <br />UNDERGROUND TANK (MONITORINGIRF,MOVAL) L] DOG KENNEL ❑ DAIRY ( <br />FIE <br />ZARDOUS WASTE GENERATOR ] CHICKEN RANCH ElWASTEWATER TREATMENT PLANT <br />RED PERMITTED FACILITY ❑ MOTELIHOTEL E]PUMPER TRUCKNARD/CHEMICAL TOILETS <br />T'roo/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAI. WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List up to ton 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 flies will be 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 EHQ 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 />5. If you need further assistance, please contact Diane Martinez, at (209) 468.3426. <br />EHD USE ONLY <br />'' <br />1. <br />2. <br />Street ii <br />� 5a 5 <br />a L4L4 <br />rr <br />FILE ADDRESS <br />Street Name <br />Y `� es l C r cr �I�Ju y <br />Way <br />C <br />e r4t <br />o vt <br />City <br />�oc �C a (n <br />5 oc k�Cr <br />1 <br />VN <br />cJ � • <br />EHD USE ONLY <br />��� Unit 1 <br />r �E /V0 I� h I y <br />fP._ unit 2 <br />01.1! /t)4 <br />5.4 Unit 3 <br />nit4 <br />t <br />40 <br />Lj unit s <br />- ❑ Unit 6 <br />n� <br />t% <br />4.S�vC <br />"2111, <br />t3. <br />9. <br />- <br />1 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES n �� <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ElSOLID WASTF. FACILITYNEIIICLI! <br />OTHER CLEANUP SITE (NDN -LOP) ❑ FOOD FACILITY F1WASTE TIRE [6 ' �A <br />UNDERGROUND TANK (MONITORINGIRF,MOVAL) L] DOG KENNEL ❑ DAIRY ( <br />FIE <br />ZARDOUS WASTE GENERATOR ] CHICKEN RANCH ElWASTEWATER TREATMENT PLANT <br />RED PERMITTED FACILITY ❑ MOTELIHOTEL E]PUMPER TRUCKNARD/CHEMICAL TOILETS <br />T'roo/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAI. WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List up to ton 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 flies will be 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 EHQ 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 />5. If you need further assistance, please contact Diane Martinez, at (209) 468.3426. <br />EHD USE ONLY <br />'' <br />