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09/25/2007 08:51 FAX 5307585672 FEDEX KINKO'S DAUIS 4002/003 <br /> DA7F.RECEIVED LHS LOG NUMBERSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Cast Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.o1 (113d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:� �Ytr1I rj w"G$�CAO _allSINESSIAGENCY: con 5"A4 (- <br /> ADDRESS: Q !a<' !iu L° tS C fT <br /> PHONE (.530 7$ � PHONE(2): CS302 902-063- FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dale of application submittal-'Tentadw only-must be confl <br /> CHECK BOX TO EXPEDITER QUEST-$H OO FEE(CAS HECK ONLY)-REQUEST PROCESSED IN 3 S A <br /> ATURE OF APPLICANT' DATE � Z H <br /> Electronic Information: ❑List[]Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street/ Street Name City ❑ Unit 1 <br /> [ 70 <br /> {� i V t�G f l ELDa ie z <br /> 2. e r TVD $ ,f <br /> 3. 112 65 N-ThoAm— oa,—A S46 �.c7c1 i - <br /> � � LJ Unit 3 <br /> 4. W. Sar e^+Roams.---3 —1�� rv4S... <br /> 51// 1 9 I Cl L;:w2r •5rac.r�►�.a vc _ f��,(� S,Q- ❑ Unita <br /> 7. j';R[1t, o LDS.I 0 ❑ Unit 6 <br /> 1-1�j I <br /> 9. l!2 1 Lo PJ- 9A 1_4a I{ -❑-Untt s <br /> 416 91-0 9 LR 9 <br /> Specific Date flange of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND YANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SoUn WASTE FACI ' <br /> OTHER CLEANUP SITE(NOH-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING(REMOVAL) ti K EL ❑DAIRY <br /> Q HAZARDOUS WASTE GENERATOR _ HCH d WASTEWATER TREAENT LANT <br /> ❑TIERED PERMITTED FACILITY EL ❑PUMPER TRUCKIYARDICHEai TOILETS <br /> ❑TATTooIBODY PIERCING $PA )K.I.AND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY THER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMITrft. A AYAILABLE FOR R>:vIEW -MONDAY-FRIDAY 8:10 AM-5:00PM -ExCLUOING HOLIDAYS. <br /> W. <br /> 1. List up to tan addresses in the space above. Select the types)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 Tiles exist. An appointment for review will be confirmed approximately ten(10) <br /> days recelpt of ppl)cation. TfiieTi et s will eh ld for sm►�iuffoffiv bustness da #or-review:-A ointments <br /> ys-- - pp --- <br /> chnnld he schedlIJeri anenrriiN1w_ <br /> 3. A file that is actively being worked on by EHO staff may not be Immediately available for review. A new application may e <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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> FHD as.oe WEB &V2W7 <br />