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Feb 09 11 09:16a Anne 2004814633 p.1 <br />02/0°/2011 99:02 20� )I 3b ENVIRONIVENTAL . .-TH PAGE 02/62 <br />DATE R7=MUE6 <br />SAN JOAQUIN COUNTY <br />c NED, ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, GA 95202-3029 <br />FES Q �G�l Telephone: (209) 4613-3420 Fax: (209)464-0138 Web: WWW.sjgov.erglehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />ENVPB���IGE (Cv�-O BUSINESSIAGENCY: - <br />ADDRESS: C V\,Q,P,5 Q-14- S t' CITYISTATEIZIP: L o CA <br />In <br />EHD 1-00 NUMBER <br />'7J��-(v <br />PHONE (1): a0 S `H '�? 3 S o`a PHONE (2): FACSIMILE: -7 j a <br />TENTATIVE" APPOINTMENT DATE: t(4 S Ya P Tlme: <br />(Please allow ill buMlness'days fr " data of lh=Uun submittal five only - must be contUmedl <br />CHECK 60X TO EXPEDITE REOLIE 22F H REOURST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLIGA k DATE _i - \ <br />Electronic Information: ❑ List [j Map - Description: <br />FILE ADDRESS <br />1� EHU USE ONLY <br />� Unit 1 <br />Sheet # Street Mama <br />city <br />1. <br />1Lra Q_ V1_ <br />J rit <br />o unit z <br />2. <br />3. <br />Unit 4 <br />D_Unit 5 <br />4. <br />5. <br />ti. <br />7. <br />_ <br />9. <br />Untt 6 <br />Un. <br />�M7 <br />Specific [Yate Range of InfonmWn Requestea: From �-- V k.- -- IC_ " % - - (::,: to <br />ENVIRONMENTAL. HEALTH )DEPARTMENT FILES p G, <br />OTo RGRaum v TANK (UST) CLEANUP SITE (LOP) F-1HOUSINGABATEWXT 3 $ Lla WASTE FACKMIVEI-ItLE <br />HER CLEMUP SrM Now -LOP) ❑ FOM FACILITY ❑ WASTE I IRE <br />MfLINDERG OM TANK (MOWORINGIRENIOVAL) C-( ❑ DOD KVNNE- ❑ DAIRY k <br />EHj4AZkRD0US WASTE GENERATC'R ❑ CHICKEN RANCH ❑ WAW WATER TREATMENT PLANT <br />TIERED PEHwrTt-D FACILrT1�)\ ❑ Mo-raJHoTm Lj PuwERTRuCKNAROCHpE,mALTOILkTs V' <br />TATTr alftDY PIERc[NG ElOLI <br />POSPA F1 LAMB USE APPLICATION SITES IOU( <br />❑ MEDICAL WASTE FACMY ❑ OTHER TLEASE SPECIFY) <br />WELL: AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW', MONDAY -FRIDAY 8.00 Am-5:00Pm (ExCLUDING HOLIDAYS) <br />1. 1st up to ten addreases in the apace above. Select the type(s) of files from the list above by ebackling the appropriate <br />box(es)_ At least one fila typo MUST be selected. Fax to (209) 484-0188 or rnail to tho add $s indicated aboyo. Address <br />ranges will not be accepted - for additional asslslance with file addr'o"Os, 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 w0l be confirmwel approximately ten (101 <br />days atter receipt of application. The files will behold for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3. Q file that is setively haing worked on by EHD staff may not be Immediately avaitabla for review. Anew app aatloh maybe <br />submitted when the file Is available. <br />4. Any file not natvme sm <br />ed in thae condition as released will be reorganlzed by FHD staff at the expense of the applicant. <br />Future flie rt ows by the same applicant may require a $122 depasit prior to inview. <br />_ _ _ EKD USE ONLY <br />