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03/24/2009 22:10 FAX 20983274'6 � U001/001 <br />43/13/2009 FRT 9:36 FAX -2-013433 SJC END f�jG02/OG2 <br />9ATE RSrEIV ¢ <br />( ���, I SAN JOAQUIN COUNTY EHD roc NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />AR 21 5 2009 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone, (209) 468-3420 Fax: (209) 464-0138 Web: wvm,.Sjgo hZZ('e <br />E N`'fl CII` I; i 1s ! LjEA+ T I -I <br />r,r.- IS'' li —e PUBLIIC RECORDS RELEASE APPLICATION <br />APPLICANT:�I rlkq i� � �� � �N� BUStNESS1AGENCY; <br />ADDRESS: �. All <br />n(� D�_p CltylS�SyatelL�ijp _�,-,.-�_�/�g <br />PHONE (1)I D �f _ PHONE (2); [1 J-- ! ! -` ✓ ' (1 .�FACSIMILE..�FJ� _ <br />TENTATIVE* APPOINTMENT DATE� d ©O 1 Time: - <br />(Please allow 1 C business days from date of application submittal - 'Te ative only - must 4e confirmed) <br />CHFCK BDx TO EXPEDITE ��������ROCESSEDPR(3CE5SE6 IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 3 -- r <br />Electronic Infofmation: ❑ List Q Map — Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name City - <br />�. U <br />z, <br />nit 2 <br />4• - �_— Unit 3 <br />5. - — -- <br />ti. _.._..... a nit of <br />7, — - <br />❑ unit 5 <br />9. <br />10 — — 11Unit G <br />Specific Date Range of Information Requested: From j Iia N G moo to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />1UNpERGR0k1ND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING AWEMJ NT ❑ SOLID WASTE FACILITYIVEHICLE <br />h THER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY WASTE t9 Oil <br />fd�NDERGROUND TANK (MO1I1O1IN01R5MOVAL) ❑ DOG KENNEL (� [)AIRY i I l 7 I V <br />AYAROOUS WASTE GENERATOR (x 173 C.Hlr KEN RANCH 17 WASTrWATER TREATMENT PLANT <br />11 TIERED PERMITTED FACILITY V 13 MOTELiHo7EL 0 PUMPER TRUCKfYARD1CHEM TolLETS <br />173 TAT7001B00Y PIERCING Q P000SPA 11 LAND USE APPLICATION SITES <br />CI MEDICAL WASTE FACILITY OTHER (PLEASE SPECIFY) t <br />WELL AND SLPTIC PERMIT RECORDS ARE AVAILAB§ E FOR REVIEW • MDNDAY-FRIDAY 6;00 AM-5;GGPM , EXCLUDING HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the type(s) of files from tate list above by checking the appropriate <br />box(es). At least one file typo MUST be selected, Fax to (2091464-0138 or mail to the address indir <br />pated 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 fife 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 $105 deposit prior to review, <br />EHD URF ONI Y <br />-� �o w1 - - - - �►�p Cf1l72ZZ <br />n �' <br />