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06/19/2010 Q8 34 FAX 91695299 Geocon Consultants I�j001/001 <br /> DATER �J EHD LOG NUMBER <br /> SAN .IOAQUIN COUNTY <br /> 1r�$ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> p(I ft (209) 468-3420 Fax: (209) 464-0138 Web: wwwsjgov.org! hd <br /> 11 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Pi r.w IZOI. EJ BUSINESSIAGENCY: G CAnS COt d St 5. -r5 <br /> ADDRESS: DR CITYISTATE2IP: &j L'rg0 CyRm SCA <br /> PHONE 85Z-r{ PHONE FACSIMILE:(_1jQo) S5;7_ -CI( 32- <br /> TENTATIVE^APPOINTMENT DATE: (O Time: I ,00 <br /> (Plana allow 10 business days from date of application submittal-•Tentative only-must be contlrmod) <br /> CHECK BOX TO EXPEDITE REQUEST-$1722 EEE(CASHORCHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG ATURE OF APPLICANT DATE <br /> Electronic information: ❑ List Q Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> st <br /> rte, <br /> Street of Street Name city l� <br /> OI 4[GoR rI 5 7X-Jt'1'bwS IUt7 r ND III, <br /> I ^ <br /> .�' $� r.(c�..{ _ c - — nit 2 <br /> �1_ 3 �•Z! t C5 oRYH t r DC-K A ? I <br /> 4. -55'D 40.b e�+J U 2 nit 3 <br /> s. 4 U ES/c0/y <br /> 6. nit 4 <br /> 7`. <br /> fl. [Iunit E <br /> 9. <br /> 3 eclficD5bRdn9 frIArra Requested: From to <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ADp7EMENT SOLID WASTE FACT M Nl J <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD IF WASTE TIRE "' <br /> UNDERGROUND TANK(MONITORINWREMOVAL)r� ❑DOG KENNEL PDAIRY �' �AY <br /> HAZARDOUS WASTE GENERATOR a ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT y <br /> TIERED PERMITTED FACILITYp✓\ ❑MOTELIHOTEL PUMPERTRUCKIYARDICHEMICAL TOILETS )_1 <br /> TATTOOIBODY PIERCING ❑POOLISPA LAND USE APPLICATION SITES 'Lt/ <br /> f MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PNI 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(ea). At least one Me type MUST be selected. Fax to(209)464.0196 or mall 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 recelpt of application. The flies 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 He is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EMD staff at thst the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. ,rye <,_ <br /> eHDNREONLY ",r ( <br /> n <br /> ;)Ael <br /> � n - <br /> i in <br /> 3 <br /> lHDd o0 orr2elt <br />