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04x' 11 / 2005 09 : 08 209-57c '925 MODESTO ATCg � q q AGE 02 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT RJSH <br /> 304 East Weber Avenue, 3nd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: w,}}Ilyokofil" " 9= so <br /> PUBLIC RECORDS RELEASE APPLILUCAIITkQN, 1, ' <br /> SIN <br /> BUESSIA ylA H •Ir S <br /> APPLICANT: Kuno(t✓� <br /> ADDRESS: 111 Lea ha(w. Ave S 1 e. I • e o CA q <br /> , <br /> PHONE (1); Z-00 ' 514 - -22T. 1 PHONE (2): a1� <br /> FACSIMILE: 209' 571 • Y22 f <br /> TENTATIVE' APPOINTMENT DATE: 4 - 1 - C) 5 Ti :m <br /> (Plea" allow 10 business days from dab of applluaon tubmltbl • 'T�nbew only - must les coldlrmed) <br /> CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT %�" — DATE 4- 11 - oS <br /> UNITDISTRIBUTION 171 Unit 1 O UnIt2 O Unit3 O UnH4 O UNtS O UnIt6 O Other (eleolrurllMlaWmsM) <br /> 111111114 <br /> FILE ADDRESS EHD USE ONLY <br /> stmet 9 street Name ems' <br /> 1 . 151 $ S. Freg"o Ve <br /> J— <br /> 2. <br /> 3. twe <br /> 4. _ <br /> 2tw5 r:.rt S r { SI^, ) ` `i 1111111- <br /> 5. d41 N+v `b k t <br /> 6. 9 AW T%III.I <br /> 8. ZVI1 A4 DreI <br /> 9. - <br /> 10. � <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT O SOLID WASTE FACIUTYIVENICLE <br /> )a,OTHER CLEANUP SITE (NON{OP) E3 FOOD FACILITY OWASTE TRE <br /> UNDERGROUNO TANK (MONITORING/REMOVAL) MDoe KENNEL ODMRY <br /> HA7ARDOUa WASTE GENERATOR 0CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0R10TELIHOTEL O PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOIBOOY PIERCING 17 POOLISPA D LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVMUBLE FOR REVIEW - MONDAYIFRIDAY 8:00 AM•S:OOPM EXCLUDING HOUDAYS. <br /> 1 . List up to ten addresses In the space above. Select the type(s) of files from the list above by Checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mall to the address <br /> indicated above. Address , ranges will not be accepted - for additional assistance with file addresses, contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10) days after receipt of application . The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> EHO 41 <br /> 111 0 <br />