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From:Marcus H. Bole & Associates 530+633+0119 05/18/2012 10:22 #239 P.001 <br /> DAT� E � SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton, CA 95202-3029 <br /> �`� Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> �RIVlRO�ME��Av G�LTN PUBLIC RECORDS RELEASE APPLICATION <br /> P - <br /> APPLICANT; & e BUSINESSIAGENCY: <br /> ADDRESS: 0 Lt i City/State/Zip U" <br /> PHONE(1): 33-6PHONE(2): �j30 ! 1J `6a3 CG) FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE: r N /My 2 S <br /> 11-l�StG Time: <br /> (Please allow 10 business days from date of applicationsubs*Tentative only-must be confirmed) <br /> L] CHECK BOX TO EXPEDITE REQ T-$105 FEE_E_JC,AS�OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SIGNATURE OF APPLICANT _1��.�` DATE — <br /> Electronic Information: ❑ List❑ Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name — City <br /> 2. m h <br /> 3. <br /> 4 �� Unit 3 <br /> lip U)or rit4 <br /> 7. _ <br /> L. PygApv N4T )ALO ❑ Unit 5 <br /> $. <br /> 9. <br /> 10. <br /> P Unit 6 <br /> Specific Date Range of Information Requested:From to ` �Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 4 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENTSOLID WASTE FACILITYEHtCLE � <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ASMASTE NTIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) OIt- ❑DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0111- 17 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOWBODY PIERCING ❑POOUSPA ND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)AA Te a 1 Z W✓+g <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:0 - 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 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. f� <br /> EHD US ONLY / V t <br /> l`&V J , <br /> ` J <br /> (Aed1-P_ z;Po_ <br /> < _ <br /> EHD 411-06 8104/08 . pro L1, <br /> 5( j <br /> o �7'9�SI o d 0. . I,„ f1S ar,nf1 ._enu : . • _ ur_ ,IO S I SVefrm.-.,nc�In.fUl1 4,L <br /> 1 z , <br /> I <br />