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From:Marcus H. Bole & Assoc,�es 530+633+0119 051- . J2012 10:22 #239 P.001 <br /> EHD LOG NUMBER <br /> ����fE�,� SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2012 600 East Main Street, Stockton, CA 95202-3029 O <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd {l <br /> LTN v <br /> �NvtRCNM�N��V►GE PUBLIC RECORDS RELEASE APPLICATION <br /> P -- <br /> APPLICANT; U Il e. BUSINESS/AGENCY: [ G i o C4 <br /> �r <br /> ADDRESS: City/State/Zip <br /> PHONE(1): CJ PHONE(2): 3c) f IS �(,f/�d�� CtG� FACSIMILE: "(a�����_T_ <br /> TENTATIVE*APPOINTMENT DATE: r���Y RS If_aSrjfe_ TimeAv _ rim <br /> (Please allow 10 business days from date of application submittal lT*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQ T•$105 FEE CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SIGNATURE OF APPLICANT —� ? T P DATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Name city <br /> [i Unit 1 <br /> ,. 11410 _ 5. r4 ST <br /> MON <br /> 2• r- 5- Nfl ❑ Unit <br /> Unit 3 <br /> 4.5. <br /> Unit 4 <br /> 6. <br /> • 7• i`.�i L 0S N p ❑ Unit 5 <br /> 8 0-)Lf` I_ N� <br /> 9. p{�G��Q n Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From ' <br /> Y T W51c to <br /> ENVIRONMENTAL HEALTH DEPARTMENT,,F,IILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) i3 HOUSING ABATEMENT X!SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY AWASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) <br /> 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOIBODY PIERCING M POOLISPA //� �Lj�i D USE�ArPPPLICATION SITES <br /> P MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)1t 20 hOii�K—�/-- LY,kk <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:DOPti - 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(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 END 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 US ONLY _A0 <br /> s emirs r i . L <br /> l _ <br /> EHD 48-06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />