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05/03/2010 14: 57 4085597ROl AEI SAN JOSE PAGE 01/01 <br /> MD E(j":::: <br /> DATE RECEIVED. EHD L013 NUMBS <br /> 3 �liia SAN JOAQUIN COUNTY <br /> 1 s�1iN,111 <br /> YN ,��`C <br /> l'i; ENVIRONMENTAL HEALTH DEPARTMENT <br /> E! il�,�_N i,_I.1 I ,� ` 600 East Main St. Stockton CA 95202-3029 <br /> Ft i vii I;'SF"I yl"VEI�lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a L I Q)- 1 BUSINESSIAGENCY: U <br /> ADDRESS: Cj �j�� a CITYISTATE2IP: J 4CZA 0 co <br /> PHONE(1): l Zq Cj Cid PHONE(2): uU 931 _X-,'b d FACSIMILE: 14-CQ I l <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST- t rFE (C H R CHE K ONLY).REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / DATE LJ — <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 25 Tr G LVDP . <br /> N <br /> �/ U"� GSI <br /> IV VD, " [�Unit2 <br /> 3 23 W 1 L fzD �� , u 0Es,;c) w/�I <br /> 4. Unit 3 <br /> 5. <br /> 6. <br /> '�(Unit 4 ,1 <br /> 7. !� <br /> 8. <br /> 0 Unit 5 <br /> 10. <br /> []Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTA TH 171LPARTMENT FILES IEMJI <br /> �MNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> JNDERGROUND TANK MONITORINGIREMOVAL ❑WASTE TIRE Z <br /> ( )a ❑DDG KENNEL DAIRY❑ ( <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH El WASTEWATER TREATMENT PLANT �/J (ll�� <br /> MLJ 'ATTOO/1300Y <br /> IEREO PERMITTED FACILfTY [IMOTELIHOTE4 [:1PUMPER TRUCKNARDICHEMICALTOILETS <br /> PIERCING [IPOOLISPA L]LAND USE APPLICATION SITES <br /> ElMEDICAL WASTE FACILITY ZOTHER(PLEASE SPECIFY) OI V� <br /> WELL AND SEPTIC PERMIT RECORDS ARE;AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:DO AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax W(2091464.0138 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 EHP 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 EHID 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 /> EHD USE ONLY <br /> i yTIn <br /> �o A� tj <br /> SMD de-06 W27Ie9 <br />