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u�lFalcuu� Fl.:1C5 F7Fa3/:70�YJ7 .... 1JL(AUK1JUKN UUNbULI1NU ..---b1 <br /> r <br /> EHD I.DG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 1 3 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 469-3420 Fax: (209)464-0138 Web: www.sigov.org/eh <br /> WARNMENT. HEALTH <br /> c �r10F� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: , BUSINESSIAGENGY_ BLAc_&RIre_A1 �_1eNtuj177A(6, <br /> ADDR1=Ss: _FggVr. S -,ReET — Cltyrstatorzlp I&/gsr_ 513 RAMENTO CA 9161691x�.�7_ fAC31Mlf_E: � - - 7 <br /> PHprtE(i): � - PHONE(2): -I-V V2 <br /> TENTATIVE"APPOINTMENT DAT = T1rem. /D 6-e'n_ <br /> ate of app lcatlon submlt(al-'TIIMHVe on <br /> (Please allow 10 business days trom dly-must 6e confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$103 FEE(GASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-^Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A _ Street Name City Unit t <br /> ;..1 20 ,.0A- /11A��✓_ 5 39 Ar-b-6119 <br /> Unit 2 <br /> z. . .1Y8.a ... Nr _ R _ 35a ,3 oa r <br /> 3. SAS # �7 <br /> _. _.. _.,.. .. nit 3 <br /> 4. _ <br /> 7• ❑ unit b <br /> - - <br /> 10- <br /> Specific Date Range of Information Requested:From g to 2g E _"A1T <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HoLr.4NG ABATEMENT El SOLID WASTE FACUTYIVEHICLE <br /> W OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 13 WASTE TIRE <br /> III UNDER4RpUNuTANK(MOMTOR1N011REMOVAL) M OoG KENNEL 0 DAIRY <br /> N HAZARDOUS WASTE OENERATOR 0 CHICKEN RANCH - 13 WASTEWATER TREATMENT PLANT <br /> M TIERED PERmrrmn FACILITY 17 MOTFLIHOTEL ❑PUM PEM TRUCKIYARDICHEM TOILETS <br /> CI TATTOOMODY PIERCING 0 POOLJSPA ■LAND USE APPLICATION SITES <br /> CJ McotCAL WA8TG FAciuTY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-6:0015M - EXCLUDINVIHOLIDAYS. <br /> 1. twist 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(2031464-0138 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 /> 5:00 pm will be praceesod 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 ton (10) <br /> days after receipt of application- Tho files will he 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 immedlately 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$405 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />