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004/27/2009 16:16FFAX 916 817 474 H D R ENGINEERING .r� C�j001 <br /> VEL=A EHp LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> APR 217 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> H 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRON NT.�EA4 e'fephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgoZ* <br /> P <br /> RMI C SRVtOES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AP PLi-A tJ 1 1M }�— _ BUSINESS/AGENCY: �T-- <br /> ADDRESS �.3�J IRQ+�} f aJl. � {��, CitylStata/Zlp' Tb LUSO _� _ff�3Ca <br /> PHONE(1I� 91 ,!Z1 _7't2'2 PHONE(2): FACSIMILE: I(O 1 ' 4`7 <br /> TENTATIVE*APPOINTMENT DATE. o9 0 <br /> Time: <br /> (Please allow 10 business days from date df application submittal-`7entative only-must be confirmed) <br /> 11 <br /> ❑ CHIE0K BOX TO EXPEDITE RE=QUEST-$105 FEE(GASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATPRE OF APPLICANT DATE d <br /> I <br /> C Electro is Information: ❑Llsf❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 1 Name <br /> ame cGcity <br /> J�l <br /> Unit <br /> 1 <br /> Unit 2 <br /> 2. HiddPp <br /> 3. Unit 3 <br /> 4. ttw <br /> 5. lv Unit <br /> 6. 1 W, t <br /> 7. © Unit 5 <br /> $, I] Unit 8 <br /> 10. °}--- <br /> Specific date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> - JUNDER ROUND TAMIL(UST)CLEANUP SITE(LOP) ❑HOUSING AeATEmENT ❑SOLID WASTE FAC1LrY/VSHICLE <br /> 0 O-niEtt LEANUP Sar(NONE Op) 0 F000 FACILITY ❑WASTE TIRE <br /> ' tJNDERROUNOTANK(MONrrORINGIREMOVAL) 0 bor,KENNEL ❑DAIRY <br /> ❑HAZARE Dui WASTE GENERATOR M CHICKEN RANCH 0 WABTEwATER TREATMENT PLANT <br /> 0 TIERED 5ERmmmo FACILrrY ❑MOTROHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TAT-roc ODY PIERCING C3POOLlSPA 0 LAND USE APPLICATION SITES <br /> ❑MEDICP WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> q WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvIEw -MONDAY-FRIDAY 8.00 AM-S:00PM - EXCLUDING HOLIDAYS. <br /> 9_ List t p to ten addresses in the spate above. Select the type(s)of files from the list above by checking the appropriate <br /> box( s). At least one file type MUST be selected. Fax to(209)'454-0138 or mail to the address indicated above. Address <br /> rang s will not be accepted—for additional assistance with file addresses,contact the FHD. Applications received after <br /> 3:00 gn will be processed the next business day. <br /> 2. The BHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> dayQafter receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> sho#be scheduled accordingly. <br /> 3, A fil that is actively being worked on by END staff may not be immediately available far review. Anew application maybe <br /> subr Itted when the flit Is available. <br /> 4, Any le not returned in the same condition as released will be reorganized fay EHD staff at the expense of the applicant. <br /> Futu a file reviews by the same applicant may require a$105 deposit prior to{review. <br /> j EHD USE ONLY <br /> i <br /> EHD 40-0 6/04108 PUBLIC RECORDS RELEASE APP FORM <br /> ) <br /> q <br />