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Downey Brand LLP 4/20/2010 8 : 59 PAGE 002/002 Fax Server <br /> EL E� l� E Lam/ <br /> DATE RECEIVEb <br /> APR SAN OAQUiN COUNTY E DLoNUMaeR <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENS OWENTRMITISE HE S H 6) t <br /> 0 East Main St. Sto Stockton, C 95202-3029 <br /> Telephone: 209 468-3420 Fax: 209 464-C 138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:, L e� � _ � �� r- BDSINESSIAGENCY: o l P <br /> ADDRESS: Qom_ �1dMail, IC6_+ CITY/STATE/ZIP: <br /> 50'Grex <br /> PHONE(1): -A0-ba3o PHONE(2):_So JL4 FACSIMILE: <br /> TENTATIVE"APPOiNTMENT DATE: Time: <br /> (Please allow 14 business days from date pf app€icati on submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUE T-$115 FETE(CASH OR CHECK ONLY)-RECLIEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT_ kif� `^_ DATE_[ -111 D <br /> !_ <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> Vito �n' <br /> 2. -- <br /> 3. - - — -- - ©Unit 2_ <br /> 4. , <br /> Unit 3 <br /> 6. II <br /> 6. —-1 — ..-- ---- Unit 4 <br /> 7. <br /> 8. <br /> 9. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From 1 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK ONITORING/REMOVALV7 ❑DOG KENNEL [l DAIRY <br /> HAZARDOUS WASTE GENERATORS ❑--�CHICKEN RANCH Llif WASTEWATER TREATMENT PLANT f/ <br /> TIERED PERMITTED FACILITY 1J MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> I] MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) : 'rpt Ile r �'a 5� � rQr)rran <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDA"YT'8:UO AIN-S:OOPM(EXCLUDING HOLIDAYS) Q1Lf Mit <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 LI or"tv11!�S <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)468-3425. <br /> EFiI)115E pNLY <br /> EHb 4S-e6 _ <br /> 8127!(19 <br />