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r I <br /> 70/02/2008 "•10: 17 FAX <br /> " �}OQ1/001 <br /> EHD LOG NUM9ER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL. HEALTHDEPARTMENT <br /> OCT"2 2008 600 East Main Street, Stockton, to 95202-3029 : <br /> Telephone:(209) 468-3420 Fax: (209).464-0138 Weh, www.sjgov.orglehd <br /> ENIVIROWL-NT fflEAL.TH <br /> PERNIMSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: B U3lN E5$lAGENCY: <br /> ADDRESS: CIty/stateizip l.t' <br /> PHONE(7): '"[/� PHONE(2) FACSIMILE: i <br /> TENTATIVE'APPOINTMENT 0AT Time DPO <br /> (PIeaso allow 10 busl4901date4.CASR <br /> tlon submittal-•Tentativa Only-must b conflrmed)CHECK BOX TO EXPEDITE R FEE ONLY)-REQUEST PROCESSED IN 3 SUSIN S DAYS <br /> SIGNATURE OF APPLICANT DATE -_ <br /> Electronic Information: [IList Map--Descrlpt oln: <br /> FILE ADDRESS EHb USE ONLY <br /> Street#. Street Name city <br /> 1 a ��s1z— ❑ its. �� <br /> z, 6ur+lt 2 <br /> oZ <br /> 3. <br /> Unit 3 <br /> 5. <br /> T. , y: i - lir Unit5 <br /> 9unit 6 <br /> 10. oU. a oyl <br /> y I <br /> Specific Date Range of Information Requested:From to _� ,,1 <br /> ENVIRONMENTAL HEALTH.DEPARTMENT FILES . <br /> OERGROUND TANK(UST)CLEANUP SITE(LOP) C I HGustNG ABATEMENT LID WASTE FAC(LITYIVEHICLE <br /> iAl-ARDOUS <br /> HER CLEANUP SITE(NON-LOP) C3 FDOD FACILITY TE TIRE <br /> DERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNPL AIRY <br /> WASTE GENERATOR 1:1 CHICKEN RANCH-' STEWATER TREATMENT PLANT <br /> C TIERED PERMITTED FACILITY, 13 MOYELIHOTEL mPER TRUCK1YARo1CHEM TRILETS <br /> 0 TATTY}OIHODT PIERCING .fl POOL15PA- No USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY)_,WELL AND SEPTIC PE=RMIT RECORDS ARE AVAILABLE FOR REv1Ew - MoNOAY-FRIDAY 8:00 AM-6:OOPM -FXCLUDINa HouoAYS. <br /> 1. List up to teen 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).J§j-Q1,a.8 or mail to the address indicated akQvl._ Address <br /> ranges will not be accepted—for additional aaaistence.with file addresses,contact the EHD. Applications received after <br /> .3:.000m 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 atter receipt of application.-The flles.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 tho same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> I <br /> LCHa 4"G 9109106 RU9LIC RECORDS RELEASE APF FARM <br /> r ' <br /> 3 <br />