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01/09/2008 15:01 2093345374 WGR SOUTHWEST NOCAL PAGE 01/01 <br /> • <br /> DA , <br /> SAN JOAQUIN COUNTY EHD LOG NUM9ER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 Tj 1 0 2008 600 East Main Strect, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.6jgov.or V 7 <br /> 1rJV001\;A4F1W HEALTH <br /> PERhA!TISE�,VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_C `f" 1 (— CS'��'��4A 8USINESS(AGENCY:_LL7Ctil? <br /> ADDRESS: ��11 nni 'Q.� 5 1 Ree r U 1 Te- �D z— CA 1 J <br /> PHONE(t):acv 9I 3-J Lt — 5 (e3 i PHONE(Z): (o FACSIMILE.1Q 3 2a_'5'j 3_N <br /> TENTATIVE*APPOINTMENT DATE: 2--UO Time: <br /> (Please grow 10 business days from data of appucation Submittal-'Tenraflve only-must be conFlrmed) - <br /> O CHECK BOX TO EXPEDITE REQU ST-198.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 8)JSINEsA DAYS <br /> SIGNATURE OF APPLICANT DATE / O <br /> Electronic Information: ❑List L]Map—Description: <br /> FILE ADDRESSEHD USE ONLY <br /> Street 9 street Name Cay ❑ Unit t <br /> 1. 515 O-V we 9 <br /> 2. 350 5 4k C1,ce s 5 d,T7 ( C. ❑ Unit 2 <br /> 3. 3 on�� 610 �52os. ` ` ` /UO COS <br /> 4. 0"5W F -L° $r /lac`) Cu lt3 \ <br /> 5. ~l <br /> 6. <br /> 7. <br /> S. ❑ unit s <br /> 9. <br /> 0, Unit 6 <br /> Specific Date Range of Information Requested: From .�L,.C� to <br /> __!! ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING ADATEMENT �§pLID WASTE FACILRYNEHICLE <br /> �THER CLEANUP SITE(NON-LOP) 13 FOOD FACILm ASTE TIRE <br /> )UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DoG KENNEL :tST <br /> HAZARDOUS WASTE GENERATOR C3 DAIRY <br /> O CHICKEN RANCH ❑ <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑WASTEWATER TREATMENT PLANT <br /> CI TATi0OI90DY PIERCING PUMPER TRUCKIYAROICHEM TOILETS <br /> ❑POOLISPA 0 LAND LSE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Aw5:00PM -EXCLUDING HOLIDAYS. <br /> t, List up to ten addresses In the space above. Select the types)of files from the list above by checking the 8pproprlate <br /> box(es). At least one file type MUST be selected. Fax 20 46 -0f 3 or Sit the add as I dic ed ov 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 flies 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 EHb staff may not be Immediately avallable for review. A new application may be <br /> submitted whan 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$98.00 deposlt prior to review. <br /> EmEHD USE ONLY <br />