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E KWED ) MAR 10 �010 <br /> VC [VrD 6 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 0 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRUNIV ENr HEALTH 600 East Main St. Stockton , CA 95202-3029 <br />` PERMIT/SERVICES7eplone ; (209) 468-3420 Fax: (209) 464-0138 Web : vdwwsjgov.org/ehd <br /> Y <br /> PUBLIC RECORDS RELEASE APPLICATION A ' - <br /> APPLICANT: X7471 /cvc 2 BUSINESS/AGENCY: ��IZ GnV ronnenYcs <br /> ADDRESS : S3 � 6 Sic rt ) - ITYISTATE/LIP:_a tl- /nn <br /> PHONE ( 1 ) : .SI�-aLu �] - qH � &V+HONE (2) : -`y FACSIMI-LE:SIo - 88 = <br /> TENTATIVE* APPOINTMENT DATE: 31 ,Ip - 10 k Time : <br /> (Please allow 10 business days from date of application subml t�"'Tik isJjve only - must he confirmed)' <br /> CHECK BOX TO EXPEDITE REQUEST - $115 F AS OR CHECK ONLYkREAUT PROCESSED IN 3 BUSINESS DA <br /> SIGNATURE OF APPLICANT DATE 'S ID r1 b ' <br /> Electronic Information: ❑ List ❑ Map — Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Street # Street Name City <br /> F <br /> ❑ Unit t <br /> 1 . 9040 r 2. rn0 r% r` - G iff kms , <br /> C m C v <br /> j 2. " b-.SD � . T- n1,(�?w� S4- CL� J // o !N _ + - ;..._ r', ❑ Unit2 \0 <br /> 3' ^_��rt1� ^ ° 8211 S LC ft) F . ✓< , <br /> 4. 0 Fes— _ ��_. 'Y -:; Unit 3 <br /> 5, 8 S_ S S <br /> 6. <br /> 7 . <br /> Y <br /> 81 4 t4 <br /> t ❑ Unit 5 <br /> 9 . £mss <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: Fromm to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> ,UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ,HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ 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•5:00PM (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(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 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 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 $115 deposit prior to review. <br /> 5- If you need further assistance, please contact Diane Martinez, at (209) 488-3425. <br /> END USE ONLY <br /> EHD 48-06 8n1/09 <br />