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04/16/2013 21 :44 `FAK 0 001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> I EJr6r'� SAN JOAQUIN COUN'T'Y <br /> x; 11 -4 W) <br /> ENVIRONMENTAL DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-270 <br /> 2'07 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.arg/ d <br /> !' ';;`'" tE `��'��; PUBLIC RECORDS RELEASE APPLICATION' <br /> E L9 <br /> APPLICANT: SUS(NESSIAGENCY: <br /> ADDRESS; <br /> PHONE ltl: 411 O PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: gs 10:7 Time: I e> ,__ <br /> Release allow 10 business days from datd of application submittal-•Tentativo only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$95-00 FEE(CASH OR CHECK ONLY)-REQVEST PROCESSED IN 9 BUSINESS DAYS t <br /> SIGNATURE OF APPLICANT 1 � DATI S-111 o <br /> Electronic Info atlon: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 5treat! J Sheet Marne City CI Unit 1 <br /> 2. <br /> F. r *► a 0 l5 (] Unit Z <br /> 3. ,lL <br /> Ajc�r <br /> 4, 1.1-6 1 Ile, I D r. Ow Unft 3 <br /> f.. %silt 4" 'V <br /> +� �� Ii <br /> �. ❑ Unit 6 <br /> 9. <br /> Unit,6 <br /> 10, <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> it UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HINAINO ABATEMENT '0 SOLID WASTE FACiLITY1VFM CLE <br /> 14 OTHER CLEANUP SITE(NON-LOP) C3 F000 FAaLrry.. 0 WASTE TIRE <br /> rt UNDERGROUND TANK(Mc3NrTORINGIREMOVAL) 0 Dor,KENNEL 0 DAIRY - <br /> y HAZARDOUS WASTE GENERATOR. 0 CHICKEN RANCH C1 WASTEWATER TREATMENT PLANT <br /> Sq TIERED PERMITTED FACILITY In MOTEL/HOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS- <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA 0 LANG USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASL SPECIFYI <br /> WELL'AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RLMEw- MONDAY-FMDAY 8:08 AMI,6:OGPa - EXCLUCING HOLIDAYS. <br /> I. List up to ten addresses In the space above. Select the Vpe(s)of files from the Ilst above by checking tho appropriate <br /> box(en). At least ona file type MUST be selected. Fax to(209146_4A1138 or Mail to the addMillg Indicated above. Address <br /> ranges will not be accepted—for additional assistance with fie addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next buslness day. 1 <br /> 2, The EHD will notify the applicant If any EHD files exist. An appollltment 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 worlmd 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 retulmod In the some condition as released will be morgonized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant Inay require a 596.00 deposit prior to review. <br /> EHD URIs ONLY <br /> i <br /> END 4540 7=005 <br /> r <br /> - I <br />