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JUL-20-2010(TUE) 13: 51 Sal-m Engineering Group, Inc (FRX)90g4-R06835 P 00 1/00 1 <br /> (� I`� SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ��r D ` <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2i <br /> 2W600 East Maln St. Stockton, CA 95202-3029 ! <br /> ` 1 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sJgov.org/ehd <br /> ENVIRU\!M)EI'T ,.F ALTH PUBLIC RECORDS RELEASE APPLICATION <br /> 11 <br /> APPLICANT: f`;C a0BUSINESS/AGENCY: sc�/ern ntr,�Gtr��, Gro�rN <br /> h �J <br /> ADDRESS: CITY/STATE/ZIP:9arc Xo <br /> PHONE (1): PHONE (2): SS" FACSIMILE:�r�P� leo-co-r <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Places allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUES $ 5 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7/a4110 <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City (]Unit 1 <br /> z, bG3 Qci ;c Avc �`� ._,,.f en — Unit <br /> 3. G S ®a c, ,'C /4�rc /1 i See jOL o <br /> 4- Sv3 ac,'I-ic Avc A•.; J7et C on Zn1t <br /> S. 5-0 <br /> 6- Os ,'r ed'i Ge A c/ I V is r n nit 4 <br /> 7. <br /> 8. Unit s <br /> 9. <br /> 10. Unit 8 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Q SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USF APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDIN(3 HOLIDAYS) <br /> 1. List up to ton addresses In the apace above, Select the type(a)of flies from the Hat above by checking the appropriate <br /> box(aa), At least one file type MUST be selected. Fax to(208)484-D1.8 or m,pll to the address Indicated above. Address <br /> ranges will not be accepted-for additional aaslstanco with file addresses, contact the EHD. Applications received after <br /> 3:00 pm will be processed the next buaineas day. <br /> 2. The EHD will notify the applicant If any EHO flies exist, An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 some 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$116 deposit prior to review. <br /> 3. If you need further 229i9tance, please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHD 4a-06 V27/09 <br />