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0 0 <br /> DATE RECEIVED EMD LOG NUMBER <br /> SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202.3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov. <br /> PUBLIC RECORDS RELEASE APPLICATION VVV <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: ➢ NO(41, W;ln,n citylStatalzip �1'pe, C.- f 5-63) <br /> PHONE(1): ZOO, 61cl PHONE(2): ZOq 321 Z(76i' FACSIMILE: g-'Z gq <br /> TENTATIVE`APPOINTMENT DATE: 12-30-09 Time: E"4 <br /> (Please allow 10 business days from data a application submittal.'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUE - 05 F A I R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /.Q--/� `nB <br /> Electronic Information; © List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroetk Street Name City <br /> 304 Cacla/I Rye. IJ 12i n octJ s [-] Onit1 <br /> 2. o�c� !N fM .S D c0 oCA/ ElUnit2 <br /> A� <br /> 7 3 l0 w S , Z D2 an rq Ct <br /> a. n10 <br /> 5y— s. <br /> f15T <br /> 8. Unit 4 <br /> \� <br /> 8 l7 unas <br /> s. <br /> ❑ unit s <br /> 10. <br /> Specific Date Range of Information Requested:From to O/PJdti� <br /> T C" <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 'h <br /> ,W�,UNDERGROUNDTANK(UST)CLEANOPSITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACWTYIVEHICLE y <br /> ✓OTHER CLEANUP SITE(NON-LDP) ❑FOOD FACILITY ❑WASTE TIRE <br /> PP..aM <br /> SU�NDERGROUND TANK(MONITORINGIREMOVAL)� C3❑DOG KENNEL DAIRY, <br /> IS <br /> AZARDOU&WASTE GENERATORX ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 10 MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA 0 LAND USE APPLICATION SITES <br /> 11 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> W ELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 9:00 AM•5:OOPM . EXCLUDING HOLIDAYS. <br /> t. List up to ten addresses In the space above. Select the type(s)of files from the list above by chocking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)404.0138 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 hold 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 WIII 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 USE ONLY <br /> ) . -eq'. 10 t Z hly e0 hOuv/I a s IbZZ r g'LW' <br /> .01q tZ (14 eV tI4 U i <br /> r <br /> EHD 411.06 0/04100 J PUBLIC RECORDS RELEASE APP FORM <br /> Z9 ']Slid NOdIid039113 96LTGSSGOZ Tb:TT BOH/LT/ZT <br />