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09/19/2010 08 :34 FAX 9168529130 Geocon Consultants 0]001/001 <br /> DATE R f � EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> _0 ENVIRONMENTAL HEALTH DEPARTMENT <br /> � <br /> 1t'N 600 East Main St. Stockton, CA 95202-3029 <br /> p oli x (209) 468-3420 Fax. 209) 464-0138 Web; www.s' ov.or / hd <br /> �. 71A <br /> P` RECORDS RELEASE APPLICATION <br /> APPLICANT: c-14Pt]yj1J j BUSINESS/AGENCY: CD.LL-)C.3>t-L Czosia ;A_'-r5 <br /> ADDRESS: �((�(� (Ot.�j L1kt.c=r ( 17(Z CITY/STATE/ZIP: �a�oC�rz�D,r� S '�Z <br /> PHONE(1):(110) 8SZ--9 1 ( S PHONE(2):��-0,��(p ���� FACSIMILE:(-q( <br /> TENTATIVE*APPOINTMENT DATE: -214-(Ip Time: 11160 <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confined) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FCE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG ATURE OF APPLICANT , � ( DATE e l(9— (tZ <br /> Electronic Information, ❑ List 0 Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street iF Street Name city Unit 1 <br /> 1. w <br /> LiPaP-P- 1 C-- <br /> 2. 1 Ia0© Ko`--~k c <br /> r1 nit 2 <br /> 3. t pJi. c <br /> 4. j�T� AR-D ¢5r1 nit3 <br /> 6. <br /> 7: <br /> 9. <br /> ❑units <br /> 9. <br /> r "7 , COMM <br /> 3 )clf -D@1 Ring fha Requested: From to <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> IUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT N SOLID WASTE FACI1 <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORIWIREMOVAL) ❑DOG KENNEL FDAIRY y a <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT �. <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTooll3voy PIERCING ❑POOUSPA LAND USE APPLICATION SITES <br /> g MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA6t.E FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2081464-0136 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 EHD 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 EMD 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 EMD staff at th Rp sf the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review, ` s <br /> MO uaR ONLY �' 3 <br /> AW <br /> RHP 48-UO OV20110 <br />