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Oct, 28. 2008 10:03AM GENESIS ENGINEERING & REDEVELOP No. 0154 P. 1 <br /> DATE RECEIVED END LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, 38 Web; ww- / z <br /> Telephone: (209)468.3420 Fax: (209)464.0138 Web:www.sjgov. r hd !/ <br /> PUBLIC RECORDS RELEASE APPLICATI <br /> ADDRSSN ---- _ L�7i(,;t��_ �Q 303U8INES8/A6ENCY: CEkLis�E /.JF.�2/A7� M--re�OE✓2u�g�y6,� <br /> ADDRESS: _ / GFSS�cO \I City/Stale/Zip __ ZP0.11 A 9S•36 <br /> PHONE(i): _ 2a9 g4_�OZI _ _ PHONE(2): �za3� ?-7-57?-O _FACSIMILE; J261 y;3_35g0 <br /> TENTATIVE`APPOINTMENT DATE:_ 1jPI/4M6ff /Z/ 7409 <br /> Time: q;Od A.M. <br /> (Please allow 10 business days from date of application sUbmlllal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-005 FEE(C415H OR CHE K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ // _ DATE —IV <br /> Electronic Information; ❑List©Wrap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Slre_et Street Name - City <br /> El Unit 1�� .lea m,J Looe <br /> 2. <br /> 3. <br /> 4• nit 3 <br /> \1 <br /> 8, Unit4 <br /> 7, <br /> 8 "' —' ❑ Units <br /> 9 <br /> 10 <br /> _ ❑ unit e <br /> Specific Date Range of Information Requested:From ENVIRONMENTAL HEALTH DEPARTMENT FILES XUNDERORoUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 11 SOLID WASTE FACILITYNEHIC(tt <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ ASTE TIRENOERGROUNDTANK(MONITORINGIREMOVAL) 13 DOG KENNEL AIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MoTEUHOTEL O PUMPER TRUcKWARO/CHEM TOILE <br /> T6 <br /> TATTOOIBODY PIERCING ❑POOLISPA ❑LAND SE APPLICATION ITES <br /> 13 MEDICAL WASTE FACILITY XOTHER(PLEASE SPECIFY)/YIANITb�( r IA/ (- p M17S <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY•FRIDAY11:00AM-5:09PM - EXCLUDING HOLIDAYS. <br /> 1_ List up to ten addresses In the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)404-0138 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 END 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 /> END 46-06 B/04IGB PUBLIC RECORDS RELEASE APP FORM <br />