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SEP-25-2008 15:10 FROM:WESTERN -CHNOLOGIES 602 470 1341 TO: '14640138 P.2/2 <br /> *#..O <br /> ' lam/ SAN JOAQUIN COUNTY END LOG NUMBER <br /> l� ENVIRONMENTAL HEALTH DEPARTMENT <br /> �0Q8 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:wwrw.sjgov.org/E hd <br /> ENVIRUNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: LS- /�/"1 r i�� <br /> ADDRESS: _ -57-37 L 8-r _/ �cd^ City/sata/zIp� 6_z �a "'AIz <br /> PHONE(111/ 7 7` 7J�7 ��.Z PHON�Ej(2):l(qq�Y Z-5— X(o� FACSIMILE:( <br /> TENTATIVE"APPOINTMENT DATE: /.-z_1'Oyar � Time: <br /> (Please allow 10 bus Inoue days from data of application submittal-•Tontat/vo only-must bo conflmiod) <br /> © CHECK BOX TO EXPEDITE REQU ST-.$106 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN�3 BUSINESS DAY$ <br /> SIGNATURE.OF APPLICANT DATE - .�- <br /> I <br /> Electronic Information: []Llst Q Map-Description: 1 <br /> - FILE ADDRESS EHD USE ONLY <br /> Street X _ Stroot Namo City <br /> Q Unit'! <br /> 2. C; /PO_ _t_/� !c' 6, T._ ❑ Unit 2 <br /> 3. Ole 11 <br /> 4 <br /> 5. <br /> Unit 4 <br /> 6. <br /> 8. <br /> 9. <br /> 10. ❑ <br /> Unit 6 <br /> Specific Date Range of Information Requested:From C ' to <br /> ENVIRONMENTAL HEALTH DVARTMENT FILES <br /> jUN0 <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT ©SOLID WASTE FACI4ITY/VEHICLE <br /> THER CLEANUP SITE(NON-LOP) CI FOOD FACILITY ©WASTE TIRE <br /> ERdRONoTANK(MONTORING/ReMOVAL) C3 DOG KENNEL O DAIRY <br /> AlARDOU3 WASTE GENERATOR 0 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> XTIEREO PERMITTED FACILITY Q MOTELHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> C3 TATTOO/BODY PIERCING ❑POOUSPA ©LAND USE APPLICATION'SITES <br /> 13 MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIFY) I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW• MONDAY-FRIDAY$:00 AM-5.00PM -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)454-0186 or mail t4 the address IndlGated 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 fifes 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 flle that Is actively being worked on by EHQ staff may not be Immediately available for review. A new application may be <br /> submitted when the file Is available. 1 <br /> 4. Any file not returned In the same condition as released will be reorganized by END staff at the expense of the applicant, <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> END USE ONLY <br /> I <br /> EMD 48-OG 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />