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PROM ERAS E-1------tal, Inc. <WED)O0T 7 2009 14:02/ST. 14:01/Mo.7S0000006g P 1 <br /> DATE RE ERV0, <br /> EHD LOG NUMBER <br /> p - . . SAN JOAQUIN COUNTY. <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> OLS 7 2��q 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)4640138 Web: www.sjgov.org/e . <br /> ENVIRONi'ENT IfALTt <br /> W3 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ('Q�*� �'� ;`;;>,..'�. BUSINESSIAGENCY: &KArS !� VironMP H 1 <br /> ADDRESS: E 3,3 .: 1f/STATE/ZIP:ddb <br /> PHONE (1): _ 'fib --8` a,. Q PHONE(2): � FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Ak-A,- Time: <br /> (Please allow 10 business days from data of.ap li ation submittal.'77ntative only»must be confirmed) <br /> )( <br /> CHECK BOX TO EXPEDITE REQUEST- 115 (C H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 10-77-49 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHL)USE ONLY <br /> Street A Street Name i' City ❑Unit 1 <br /> F <br /> 3 ,'rt � .S 4,x + t <br /> 2. =0 t,r,L c ❑Unit 2 <br /> 3. 0-03tc /C� <br /> 4. 603 [ �mex- Ln GSC. Unit 3 <br /> 5 , <br /> 8. <br /> Unit 4 <br /> 7. I <br /> 8• F a ii'l nit <br /> 9 <br /> 10. s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROuNo TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACt r1YNL:HICLE' <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> JJNDERGROUND TANK(MONITORINGIREMOYAL) ;, [-]DOG KENNEL F1DAIRY <br /> I L�HA7ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MRTELMOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA '❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEAS{;SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCI:UDPNG HOLIDAYS) <br /> 1. List un to tern addresses in the space above:'Select the type(ss)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. fax to 1209),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 /> I days after receipt of application. The files will behold 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHD<8-06 <br /> #.. 8127109 <br />