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08/19/2010 08:34 FAX 916852913, Geocon Consultants [a 001/00 1 1 <br /> DATF R �" EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ,� ENVIRONMENTAL. HEALT DEPARTMENT <br /> 600 East Main St. Stockton, C,A 95202-3028 <br /> n (209) 468-3420 Fax; (209) 464- 138 Web: www.sjgov.arg! h <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> d <br /> �pp <br /> APPLICANT:} DL,.Ir.4 T BU iNESS1AGENCY:_CaiCti1 <br /> ADDRESS: t}"�A &� DR CITYISTATEIZIP: <br /> PHONE(1):(%G) Bsz-q r ( g PHONE(2). 4-O4FACSIMILE: q( g L <br /> TENTATIVE*APPOINTMENT DATE, - Time, I :o I3 <br /> (Please allow 10 business days from date of application subri Ittal-'Teel tva only-must be eonfinned) <br /> CHECK BOX TO EXPEDITE=REQUEST-$122 FEF(CASH OR CHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG ATURE OF APPLICANT DATE y(r`{ (CC <br /> Electronic Informatlon., ❑List❑ Map-De5clriptlon: . <br /> FILE ADDRESS EHD USE ONLY <br /> Streat ii stmat Name C Unit 1 <br /> F2. <br /> uk Mt <br /> 2 <br /> 3. 23 t �A.ray : "M- <br /> 4. �� � � � 00. <br /> S. ,{ � „ <br /> 6.... <br /> e. <br /> Units <br /> 3 &clfWJD�&lR1ng f a o- Requested: From to <br /> ENVIRONMENTAL HEALTH DEP RTMENT FILES <br /> UNDERGROUND TANK 01ST)CLEANUP SITE(LOP) ❑HOUSING ARATEMENT LKLSOLID WASTE FACI <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> a i <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TIRE ATMENi PLANT ''Pr <br /> TIERED PERNIMED FACILITY ❑MOTELIHOTEL PUMPER TRUCKNARDICHEMICAL.TOILETS <br /> TATTOO1Boay PIERCING ❑POOLISPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASZ SPECIFY) <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MOP DAY-FRIDAY 8:00 AM-5:00PM ExCLUDING HOLIDAYS) <br /> 1. List_uA to ten addresses.In the spate above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one elle type MUST be selected. Fax 9 464-019 all to the add regs.Indleated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will 4e processed the next business day. <br /> 2. The EHD will notifythe applicant if an EHD flies exist. An ointrn int for review will be confirmed <br /> Pp Y pP approximately ten(10) <br /> days after receipt of application. The files will be field for a maxinnurn of five business days for review, Appolntments <br /> should be echadulad 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 flle not returned In the same condition as released will be reorganized by EMD staff at th a f the applicant. <br /> Future file reviews by the same applicant may require a$122 d"sit prior to review, <br /> �:. <br /> RHO flet;ONLY �' � ;;' <br /> RHD 4a-0o OVZWO <br />