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JUL/14/2010/WED 09: 14 AM Terwn Consultants FAX No, 949-6602 P. 001/001 <br /> DATE RECEIVED CEHD LOG NUMBER <br /> " UL�� ���J �D SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> JUL 1 4 ZU 10 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org e ts <br /> ENVIRONIVILNTbEAITu PUBLIC RECORDS RELEASE APPLICATION <br /> PERIVI1175ERVCQV� / . <br /> APPLICAN t/ ��Jy1�(1�• 13USINESS/AGENCY: �rrQCQ'Y7 <br /> ADDRESS: /4�4a '7✓'�CGka., ��✓a CITY/STATE/ZIP: /t/i Q C490(0 <br /> PHONE(1): 9`J9•Jr40• �7J� PHONE(2): FACSIMILE:yv9. 0&0- 1 '73 ,• ,•, •, •,• , <br /> TENTATIVE'*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative enly-must be c:313USINES <br /> ed) <br /> CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK NLY)-REQUEST PROCESSED DAYS <br /> SIGNATURE OF APPLICANT_/ §V0 DATE <br /> Electronic Information: List❑ Ma De iptlon. <br /> FILE ADDRESS EHD use ONLY <br /> Street# Street Name City Unit <br /> 1. y7 9 9 j4a TME ,1?0R6 9-roekTod 9 <br /> 2. \ <br /> Unit \\(Y <br /> 3. do � V <br /> 4. <br /> U ' <br /> 5. <br /> 6. w <br /> nit4 C <br /> 8" ❑unit 5 � <br /> 0 <br /> 10. o <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILETS <br /> UNOERGROUNU TANK(UST)CLEANUP SITE(LOP) ElHOUme AOATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILRY ❑WASTE TIRE <br /> NDERGROUNO TANK(MONITORINGIREMOVAL) El Dor,KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR F]CHICKEN RANCH l3a WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPERTRUCKIYARDICHEMICALTOILET6 <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA LAN2il <br /> USEAPPUCATKIN SITES <br /> }'MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY �'a GEJ/7cj.WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE POR REVIEW: MONDAY-FRIDAY8:00AM-5: XCLV O HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es), At least one file type MUST be selected. Fax to(200)464-0138 or mall 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 EMD files exist. An appointment for review will be confirmed approximately ten(10) <br /> 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 revlew. 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 /> S. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD use ONLY <br /> EHD 4&06 Bf2TlOr <br />