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Jun 30 09 01 : 02p Krazan 6 Associates 55934821916 P. 1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - ----- 600 East Main Street, Stockton, CA 95202-3029 <br /> 2NO ;4 7 L <br /> �_O Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org <br /> 7 !H4x'M. PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGENCY: M-0-2ftL) + pk_�SnNfYrp <br /> "`OP'LfdA�T: Ri--D()WC, <br /> ADDRESS: 19 i_C; CORVE City/State/Zip <br /> PHONE C _ PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 71rjoi Time: L'00 P,'M <br /> (Please allow 10 business days from dateof application submittal-*Tentative only-must be confirmed7i ' <br /> XCHECK BOX TO EXPEDITE REQUEST-$105 FEE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS <br /> SIGNATURE OF APPLICANT DATE C. <br /> Electronic Information: 0 List 0 Map-Description: . <br /> FILE ADDRESS- EHD USE ONLY <br /> Street# Street Name — City Unit 1 <br /> 1. O'DIS0 M, CT-NNF_F1r'y__ 9-0 <br /> 2. l lUnit 2 <br /> 3. <br /> k1Q00 <br /> A <br /> 4. Unit 3 <br /> 5. <br /> Unit) <br /> U 4 <br /> I <br /> 6. <br /> 7. <br /> ff"Unit 5 <br /> 8. <br /> 9. <br /> Unit 6 <br /> 110. P <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING ABATEMENT XSOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY XWASTE TIRE <br /> XUNDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL 0 DAIRY <br /> ,F-HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH AWASTEWATER TREATMENT PLANT <br /> 71TIERED PERMITTED FACILITY 1:1 MOTEL/HOTEL 1:1 PUMPER TRUCKIYARDICHEm TOILETS <br /> In TATTOO/BODY PIERCING 13 POOLISPA )<LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 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 files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (209)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 /> 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 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 8104/08 PUBLIC RECORDS RELEASE APP FORM <br />