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Mar 03 2010 1 : 42PM THE UPS STORE #2503 916 251772 p , l <br /> ��I j lI , I� • EHD LOG NUMBER <br /> ,II_ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ' <br /> 0 . 800 East Maln St. Stockton, CA 95202.3029 <br /> Sphone: (209) 468-3420 Fax: (209) 4840138 Web: www.6jgov.orglehd <br /> �IdEI't;�l Lf4i `T'/- iLfit <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY:sin``-`) �/i <br /> ADDRESS: tjr CITYISTATEIZIP:G1e,/—,1 <br /> PHONE(1): Ti� 34r7 96&GPHONE(2): FACSIMILE: Z08 —!j,, <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (PI so allow 10 buslrnss days from date olappucatlon submhtal-'Tontadve onfy-must be confirmed) <br /> []CHECK 0 X TO EXPEDITE REQUE $11`6 EE(CAS 0 CH K ONLY)-REQUEST PROCE89ED IN 35 INE S DAYS <br /> SIGNATURE 0 I APPLICANT LM DATE / <br /> el <br /> El8ctronic Inform tion: © Llst❑Map— Description: <br /> _ FILE ADDRESS EHD Use ONLY <br /> 8trestt I t 8tmot Name City <br /> U `L [i . I��� L.Gn�. � <br /> a. I <br /> Urdt 2 <br /> 3. o <br /> 4. <br /> Uzi <br /> 6. <br /> �jr /1 R/�i l ! Al ✓ �L nit e, , <br /> 7. <br /> 8. <br /> 0 Unit tl <br /> 110. 1 -- <br /> Unit e <br /> Spee Ric Date Range Informadan Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r <br /> UNDEROROUNDTAN (UST)CLEANUP SITE(LOP) ❑HOUBMoABATEMENT �$OLIOWASTEFACLrrYIVEHICLE hI� <br /> OTHER CLEANUP SIT (NON•LOP) El FOOD FACILITY WASTE TIRE <br /> NDEROROUNDTAN (MOHITORIN6IREMOVAI.� ❑Doe KENNEL MARY ��01\�- <br /> AZARDOUS WASTE ENERATOR7( ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT Cts'y'��/� ��% <br /> ❑TIEREDPERMITTED F ILITY ❑MOTEUHOTEL ❑PUMPER TRUCKNARD(CFEMCALTOILETS q_;\� <br /> ❑TATTDOfBODY PIERC NO ❑PooU$PA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE F ILRY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC ERM17 RECORDS ARE AVAILABLE FOR RENEW: MONDAY^FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. In the space above. Select the types)of Ales from the list above by checking the appropriate <br /> box(ea), At leas one file type MUST be selected. F4m tv(2D9)464.0138 or mall to the address Inoicsted#WVV Address <br /> ranges will not be accepted-far additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be Processed the next business day. <br /> a, The EHD Will no�ty the applicant If any EHD flies exist. An appointment for revlew will be connrmed approximately ten(10) <br /> days after rscel t of appllcailon. The files will be held for a maximum of five business days for review. Appointments <br /> should bo ache clod accordingly. <br /> 3. A fila U1a1 b act ly being worked on by EMD 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 retU nod In the some condition as released will be reotgantted by EHD staff at ftexpense of the applicant <br /> Future file revie by the same applicant may require a$1t5 deposit prior to review, <br /> 5. if you need fu or assistance,please contact Diane Martlnaz,at(209)488,WS. <br /> ExouaE on�r <br /> EHD 46-0r <br /> Of17NG <br />