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NOV-17-2010 WED 02:26 PM FAX NO. P. 01 <br /> EHD LOG NUM81=R <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 51 <br /> NOV 17 2010 600 East Main Street, �15;tockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax. (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PER, MIT/SERVI'C/ S ��,� .�• 1� <br /> APPLICANT: M o ,, 7-t9 rn _ BUSINESS/AGENCY:✓/�nk�r_ /P^Ps'a�� LLQ° <br /> ADDRE SS: SD l- S 2ofi� CltylstatelZlp Son Fro ci c c o,r CIA 9 v�0.S <br /> PHONE(1): (y/-FS9/-7 J2 PHONE(2); _FACSIMILE: (�//sls9� -7rly <br /> TENTATIVE"APPOINTMENT DATE: _ Time: <br /> (please allow 10 business days from date,4 application submittal-"TentatlY0 only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE ICASH OR CHECK ONLY)-REQUEST PROCESSEO IN 3 BUSINESS DAYS <br /> SIGwATURE OF APPLICANT PATE i 1 - ) IQ— <br /> Electronic Information: Q List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> _Street# Street Name cid' [� Unit 1 <br /> 1. ?OO GJes f C. 4ArC4 S�rce� Sldo�fn� <br /> p Unit 2 <br /> 3, Unit 9 <br /> 4. <br /> 5. unit 4 <br /> E7. Unit 5 <br /> ❑ Units <br /> 9. <br /> 10. <br /> 2 a l 0 to f�t o u d 4.4e <br /> Specific Date Range of Information Requested:From _ (aS� 1� PrI o <br /> ENVIRONMENT AL HEALTH DEPARTMENT FILES <br /> 13HOUSINe ABATEMENT 13 SOLIP WASTE FACILITYNEHICLE <br /> N06RGROUND TANK(UST)CLEANUP SITE(LOP) M I'000 FACILITY ❑WASTE TIRE <br /> IXPTHER CLEANUP SITE(NON-LOP) ❑oOG KENNEL C3 DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) (�,wHICKBN f2ANCN ❑WASTEWATER TREATMENT PLANT <br /> FIAZARDOUs WASTE GENERATOR ❑MOTEUlIOTEL 0 PUMPER TRUCK/YARPIGHEM TOILETS <br /> /❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATYOOBODY PIERCING p OTHER(PLEASE SPECIFY) <br /> ❑MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RI VIEW -MONDAY-FRIDAY 8:00 AM-5.00PM EXCLUDING HOuOAYS �� <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 /> elected. ax to�e0s)Aaddressess 8 all to a add ss in <br /> box(es). At least one file type MUST be sApplications received after <br /> ranges will not be accepted--for additional assistance with file addresses,contact the EHD. <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 a confirmed app Appointments t e ten(10) <br /> days after receipt of application. The files will bF held for a maximum of flue business days for review. Appointments <br /> should be scheduled accordingly. <br /> t be immediately available for review. Anew epplic+ttion may be <br /> 3. A file that is actively being worked on by EHD stliff may no <br /> submitted when the file Is available. Ilcant. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the��pp <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHfI USE ONLY <br /> PUBLIC ReCORPs RELEASE APP FORM <br /> EHD 40-04 8104/06 <br />