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06/03/2008 09:51 FAI_53024316A4.�-__ <br />DATE RECEIVED <br />s. <br />CH2M HILL ,r£- f�002/002 <br />EMD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Web: <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 www.sjgov.o /e <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: n 41 2 k IK BUSINESSIAGENCY: cHzAP1111 <br />ADDRESS: 2525 Arour.tS W- <br />PHONE(1): .`:3' ?2+1 �..�- PHONE (2): FACSIMILE: 5-3-.?'�3q-32Ni <br />TENTATIVE` APPOINTMENT DATE: b 17 1s Time:(h2 <br />(Please allow tan business days from date of application submittal-•flentadve only - must bo confirmed) <br />❑ CHECK BOX TOEXPF-DITE REQUEST -$91.00`F�rE��(pC ASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DAYS <br />SIGNATURE OF APPLICANT VIN/ DATE 6IZfe$ - -- <br />Electronic Information: ❑ List ❑ Map- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />street.# <br />Street Name <br />City <br />El Unit t <br />unitz <br />1. <br />z• <br />3"130 <br />3"3? <br />N,S. ElOora�D <br />S�Dof$ <br />- <br />3. <br />32Ua <br />S. E porwto <br />i. /VF,F <br />4. <br />2aG:_ <br />�� �? K <br />,%`,F <br />Unita <br />S• <br />5 Qi mt OA <br />cJ <br />unit d' <br />7." <br />3)..5 <br />( OvoLdc ,1 <br />8. <br />032 <br />1, TT <br />_�''$ 7 <br />❑uniis <br />s. <br />284� <br />HtZn� 54 <br />d �9 <br />70. <br />80 ( <br />(�a( Avt <br />/ F <br />nit <br />specific Date Range of information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />n UNOERGROUNu TANK (UST) CLEANUP SITE (LOP) 171 HOUSING ABATEMENT WSOUDWASIE PACILIWNEHICLE <br />IMER CLEANUP SITE(NOFD FACILRY eWASTE TIRE <br />N-LOP) OO <br />NDERGROUND TANK O DDD KENNEL O DAIRY <br />YYJ{�'AZARDOUS WASTE GENERATOR 0CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br />LY TERED PERMITTED FACILITY 173MOTEL/HOTEL 5PUMPER TRUCKIYARDICHEM TOILETS <br />TATTO01BODY PIERCING - 0 POOUSPA N] LAND WE APpucATION SrnEs <br />❑ MEDICAL WASTE FACILITY WOTHER(PLEASESPECIFY) )Ag'tl nJrneb-C. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRJOAY 8:00 Aw6:OePM - 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 (20914114.0138 or mail to the above address. Address ranges will <br />not be accepted - for additional assistance with file addresses, contact the END. Applications received after 3:00 pm will <br />be processed the next business day. <br />I The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ten <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 the EHD staff may not be immediately available for review. A new application <br />may be 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 $98.00 deposit prior to review. <br />EHD USE ONLY <br />