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04/24/2009 12:56 SIF- 'a DELTA CONSULTANTS LLC 4 120946401: NO.955 Dt71 <br /> I <br /> EHQ LOG NUMBER <br /> no <br /> EcIETED <br /> SAN.IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2 4 2009 304 East Wcber Avenue, 3`a Floor, Stockton, CA 95202-270 <br /> Telephone:(209)468-3420 Fax:(209)464-0139 Web;www.sjg0v.0rg/ <br /> Z? <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/ <br /> APPLICANT: G Q� BUSINL 3SIAGENCY: <br /> G FACSIMILE: a �30Q <br /> PHONE(1): S' 3 l' PHONE(2): <br /> TENTATIVE'APPOINTMENT PATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> D CHECK BOX TO EXPEDITE REQUEST•>;As.O0 FF ASH 0HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT S k'tow DATE A'24,Ol <br /> UNIT DISTRIBUTION 17 Unit 1 ❑Unit 2 0 Unit 3 O UNt 4 0 Unit 5 b Unit 8 ❑ Other(.Iecb'onlclliats/ntaps) <br /> FILE AMIRESS HD USE ONLY <br /> Sheet N Street Nam. city <br /> 2. 1 5 <br /> � S. <br /> 6. - <br /> 7. <br /> e. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �UUTN13.0 <br /> rjJY <br /> NOERORoUNo TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT ❑SOLID WASTE FACILITYNeHICLE ' Q <br /> ER CLEANUP SITE(NON-LOP) /I 0 FOOD FACILITY 0 WASTE TIRE <br /> 1iNDERGROUNoTANK(MONITORINGIRFMOVAL)�^ 13 Doe KENNEL 0DAIRY <br /> AL4RROU9 WASTE GENERATOR ` 0 CHICKEN RANCH M WA5TEWATER TREATMENT PLANT <br /> ,�H0 MOTFJ MOTEL ❑PUMPER TRuCKIYARDICHEM ToiLETS <br /> O TIERED PERMITTED FACILITY ❑LAND USE APPLICATION SITES <br /> O TATTOOIBODY PIERCING 0 POOLISPA <br /> C MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:0oPM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax jo 209 40-0138 or II to he address <br /> in icated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the END.Applications received after 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 <br /> approximately ten(1 D)days after roceipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> V I - -- <br /> FND sidlm� <br /> 1H4MS <br />