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u1i1014UUV 10:04 ran 8001 <br /> DATE RECEIVE EHD LOG NUMBER <br /> Gu �14 D SAN JOAQUIN COUNTY <br /> 1� V L�IuJ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA <br /> 38 Web: 3029 <br /> JUL 1 `] 2009T¢lephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org L <br /> EMJIRNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> r QI:QVIrrGe Ae I <br /> APPLICANT: DYIAAVLA 1•1,,�1 iO ck, BUSINESS/AGENCY: 1-Fligalimw 60IOCU.LTLN[, <br /> ADDRESS: A�_nlaQt�l City/State/Zip . 01tJe t (b ORtaij A <br /> PHONE(t): Q _.-(eB I TLB�I PHONE(27): q���3�I�I�Z?Db FACSIMILE: <br /> 4 <br /> TENTATIVE"APPOINTMENT DATE: f-21-D q Time: <br /> (Please allow 10 business days from date of application submittal.'Tentative Only-mustbe onfirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 7-/I;-b9 <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE OVn <br /> Street Street Name City qrA <br /> 1'2• 2 A!3• 7 N.a. 3 ,.1Of S c rk1N ✓rt3olt+111'�*-5. IW �o ( <br /> 6. <br /> 7. <br /> 6 ❑ Unit 5 <br /> 9. <br /> 10 ❑ unit s <br /> 1 I <br /> Specific Date Range of Information Requested: From JA e.%4!61M to Orem <br /> IX <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES q dl �� <br /> XUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE �Q f/r 5 <br /> OTHER CLEANUP SUE(NON-LOP) ❑FOODFAciuTY ❑WASTE TIRE �� �'J(-t 3 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)k ❑ DOG KENNEL ❑DAIRY <br /> HAZAROOus WASTE GENERATOPO4L 171 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT -G/-GMI <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMTOILETS <br /> 0 TATTOOIBODY PIERCING ❑POOL/SPA ❑LANG USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> t. 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(209)464-0138 or mail 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 EHD 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> n <br /> -4- - Y N <br /> EHD 49-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />