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05/26/2010 13:45 17078773276 ANTON PAGE 01/01 <br /> DgTE 96�X&G�­i— <br /> r,) 0 EHD LOG NUMBER <br /> SAN JOAQUIN <br /> C61W, 0 Awft <br /> 1"17T. <br /> ENVIRONMENTAL HEAL M <br /> EOMARt <br /> 1,j LU IU 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone; (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd5 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> PEP,,` <br /> APPLICANT: k'cw o� BUSINESS/AGENCY: 2N-T-0tij <br /> ADDRESS: 26 &.�< 3-7(> CITY/STATE1ZIP:_E44/_, (�A <br /> PHONE(1): lb-7`' 72--327PHONE(2): J-M�-377-S-707FACSIMILE: <br /> T 'TATIVE*APPOINTMENT DATE: Time- <br /> (Please allow 10 business days from datif of appficationubmittal­Tente6veonly-must be confirmed) <br /> _GBOX TO EXPEDITE REQUES EC 0 REQUEST PROCESSED IN 3 BUYNES WAYS <br /> SI <br /> T CK E OF APPLICANT <br /> Electronic Information: [] List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> Unit i <br /> q5-5q 5. c L_ <br /> 2. El Unit 2 <br /> 3. <br /> 4. .W Unit 31 <br /> 5. <br /> 400" <br /> 6. <br /> AN. Qge4 <br /> T <br /> 7. <br /> '0000 <br /> 0 Unit 5 <br /> 9. <br /> Ev Q Unite <br /> 5�6'clfloid`lO]Rinj IP #jn Requested: From to <br /> K [:1 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M P)ERGROUND TANK(LIST)CLEANUP SITE(LOP) HOUSING ABATEMENT E]SOLID WASTE FACILiTYNEHICLE <br /> E�MTHCR CLEANUP SITE(NON-LOP) 7 FOOD FACILITY Ll WASTE TIRE <br /> [1j$DERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL M DAIRY <br /> [v]'HAZARDOUS WASTE GENEPATOI� []CHICKEN RANCH [I WASTEWATER TREATMENT PLANT <br /> [J TIERED PERMITTED IFACILITYV` El MOTELIHOTEL Ej PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> El TATTOO/BODY PIERCING ❑POOL/SPA El LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY CJ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE_AVAILABLE FOR REvim: MONDAY-FRIDAY 8,00 Am-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ton 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)464-0138 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 /> 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 ton(10) <br /> days after receipt of application. The files will be hold 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 now 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$115 deposit prior to review. <br /> 5. if you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> PHI)USF ONLY <br /> EH D 48-08 8127109 <br />