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Dec 09 09 12: 20p Krazan & Associates 559 82190 p. 1 <br /> SAN NTY EHD LOG NUMBER <br /> ENVIRONMENT EALTH DEPARTMENT <br /> DEC 0 9 2009 600 East Main Skeet, Stockton, CA 95202-3029 <br /> WI hone: (209) 468-34 - (2 9)464-0138 Web:www.sjgov.or UJ/ <br /> ENVIRONMENT HEA Pi <br /> PfMITiSERVICES PUBLIC RECOR f EASE APPLICATION <br /> APPLICANT: . BUSINESS/AGENCY: At� o�I aPtT�5 <br /> ADDRESS: ( • J telzip C:i`AJ ei3 Al <br /> PHONE(1): 5-59 (4 P-00 PHONE(2): FACSIMILE: 5,51 -3 S6-A I e1� <br /> TENTATIVE'APPOINTMENT DATE: Tl Lp Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST- 5 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List[] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street X Street Name City Unit 1 <br /> 1. qr) jFepws� a.-r- C,cg . Sic �T <br /> 2. jGa I I t a Unit 2 \ <br /> 3. 1t tl \ <br /> 4. <br /> 5. 0 o9 g 9r. <br /> 1, <br /> 6. g^nit4 <br /> 7. <br /> 8. ❑ Unit 5 <br /> 9. <br /> 10 Unit 6 <br /> M <br /> Specific Date Range o fo ation Requested: From to <br /> ENVIRONMENTAL HEALTH. T PARTMENT FILES <br /> Jg UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT WSOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> J��.�.//HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH St WASTEWATER TREATMENT PLANT <br /> /KTIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOOISODY PIERCING ❑POOLJSPA ❑LAND USE APPLICATION SITES <br /> 1K MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS. <br /> 1- List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to <br /> A209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with Ille 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. <br /> EHD USE ONLY <br /> EHD 48.06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />