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08/19/2010 08:34 FAX 811385291?w Geocon Consultants f�001/001 <br /> DATE R�OO EHO LOG NUMBER <br /> ^ SAN JOAQUIN COUNTY <br /> � (g/N ENVIRONMENTAL HEALTH DEPARTMENT 11A y600 East Main St.Stockton, CA 95202-3029 <br /> � n (209)468-3420 Fax: (209) 464-0138 Web: wwwsjgov.org/ hd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> pp , <br /> APPLJCART: R t!.0 r Dt I N I BUSINESSIAGENCY: C1 Z0=)1.1 Cw St 7L.:-&e..7r-5 <br /> ADDRESS: SDR CITY/STATMIP: .CA RS447. <br /> PHONE(1):�91fo� �SZ -�I( S_ PHONE(2)-0-0-0(oZ8-Q(o3 S FACSIMILE:01(c.) 952 -A( 32- <br /> TENTATIVE•APPOINTMENT DATE: -2�t-f0 Time: I "00 <br /> (Please allow 10 business days from date of appllcaGon submittal-'Tentative only-must be Confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG TURE OF APPLICANT_���� DATE 8 (tet I c7 <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streets Street Name City El Unit <br /> t• DI L(GOA I7i>DC1L7bnl <br /> 2. r1�-rt .-i -7E-�`).' ,},.. mkt / <br /> 3, Z 21 I�i o0.nc Y `MCA "- ,::d , �A1jJ1 <br /> 4• j rJ'O AR_ orJ nit 3 _ <br /> 6, <br /> 7. <br /> 9• ❑Unite <br /> 9. <br /> it y s <br /> SeIfIFJDlf6i'•Rl�ng dente Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACT <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILnY WASTE TIRE j <br /> UNDERGROUND TANK(MONDORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT �•'' ys <br /> TIERED PERMITTED FACIUTY ❑MOTEL/HOTEL PUMPER TRUCKIYARDICRENicm TOILETS <br /> TATToo/BQDY PIERCING ❑POOLISPA LAND USE APPLICATION SUES <br /> 4 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 0:00 AM-15:00PM IIEXCLUDUNG HOLIDAYS) <br /> 1. List up to ten r esSt up to ten addr es In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091484.0198 or mall to theFaxtof209)494.0138 orMall to the addreo Indicated a�veIndicated a ve. Address <br /> ranges will not be accepted-for additional assistance with rile 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(1 O) <br /> days after receipt of application. The flies will behold fora 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 Nle Is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at th ap of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to re <br /> RHO uar ONLY <br /> RHO 412-M 07120110 <br />