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JUL-20-2010(TUE) 13: 51 Salem Engineering Group, Inc (FRX)90"Q806435 P. 00 1/00 1 <br /> D (L� L V DD SAN JOAQUIN COUNTY EHD LOG NUMBER- ENVIRONMENTAL HEALTH DEPARTMENT <br /> tI II 2910600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: wm.sjgov.org/ehd <br /> IRUN10L�T��E,4LTH PUBLIC RECORDS RELEASE APPLICATION <br /> / <br /> APPLICANT: �;cf�" 0jad BUSINESS/AGENCY: , Icm G,,4t�ecti'oi, GrokP <br /> ADDRESS: JI�S�o /y)�ll on P do pry'✓c ,s /Ufi�' CITY/STATE/ZIP: <br /> PHONE(1): 000 S�- x-903 PHONE FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE; Time: <br /> (Plazas allow 10 business days from data 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 Iho//O <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street ff Street Name City ❑Unit 1 <br /> p <br /> 4 <br /> z. C-3 <br /> Avc unit Od <br /> 3. '7r p - i,�A�0' % <br /> 4- SU. nciY,c /TV L /..} f f JJac C on nit <br /> // //II <br /> 5. 15"01 Li/+cc/f C.tn [✓ f scic an <br /> 6. dS' r/rc�4n Ge✓. e/ l t it .n �nit <br /> 7. <br /> 8. Unfit s <br /> 9. <br /> 10- 0 Unit 6 <br /> Specific Date Rings 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 El WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING F71rr <br /> P001JSPA LAND USE 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(EXCLUDING HOLIDAYS <br /> 1. List up to ton addresses In the space above, Select the type(a)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be Relected. Fax to(2091464,0130 or mala to the address Inditated 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 E:HO flies exist. An appointment for review will be confirmed approximately tan(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 avallable 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 /> s. If you need further assistance, please contact Diane Martinez,at(209)468-3426. <br /> EHO Ube ONLY <br /> EHD 0.06 6447/09 <br />