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02/12/2009 00:09 FAX 9163722565 WALLACE-KUHL AND ASSOC. Q001 <br /> DATE RECEIVED . SAN .IOAQUIN COUNTY EHD LOG NUMBER <br /> W���U V �� <br /> WLS O V D ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 1 2 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov. r1 T 13 <br /> PElrGed <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> S-T/ecDV 'f <br /> APPLICANT: _9GE J 4 °L 64,VDA/ BUSINESSIAGENCY: W+Q��-f.A-GN - ktu/�{G ! Arree- <br /> ADDRESS: _�2S t BFA"N MtVD City/State/Zip WEST /1GR,SA19" .l'tofC.A <br /> +r �— <br /> PHONE(1): CII(r — 3 I z - I L434 PHONE(2): q FACSIMILE: 916 S-77- Z5 165 <br /> -t <br /> TENTATIVE'APPOINTMENT DATE: � -2 9 Time: Y` d 0 A-AA <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDIT R UEST-S1 FEE OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9 <br /> Electronic Information: ❑ List 0 Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City -- i- - - <br /> 1. g Z . GOR{Z� GLOW E] Unb1 <br /> 2. 2056 go 6-4.Y PAI V9 ACY 35'2 Ca ��59eoo ❑ Unit2 <br /> 3. <br /> 4. Unit 3 <br /> 5. !E03 <br /> 6. n 47. <br /> 9. <br /> nit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to P C 9 <br /> MI-611 <br /> .,,/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WL�U O ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 13 WASTE TIRE <br /> rrr NDERGROUND TANK(MONITORINGIREMOVAL) El DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> El TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> IM TATTOO/BODY PIERCING ❑POOLISPA 13 LAND USE APPLICATION SITES <br /> El 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(2091464-0138 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 applicaUon 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 8/09/08 PUBLIC RECORDS RELEASE APP FORM <br />