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08/07/2008 12:27 911586104"` SECOR PAGE 02/02 <br /> LFHQ 40(3 NUMBER <br /> LF _D <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> lephone., (209)468-3420 Fox; (209)464-0138 Web: www.sjgov.org/3 2Z3 <br /> w 91 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Debbie Herzog BUSINIESSIAGENCY: Slanted <br /> ADDRESS: 3017 Kilgore Road,Suite 100, Rancho Cordova,CA 95670 <br /> PHONE(1): Direct Line 916-384-0724 PHONE(2): Main Lina 916.861-0400 FACSIMILE: 916-801-0430 <br /> TENTATIVE*APPOINTMENT DATE: Thursday August 21 st Time: 10,30 <br /> (Ploaso allow ton business days from date of application submittal-'TantatIvo only-must be confirmed) <br /> ❑ CHECK BOX TOEXPEPiTE jE1c1iLIE&T-s9at9 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THRPENSU <br /> SUINESS DAYS <br /> r DA W <br /> SIGNATURE OF APPLICANT TE AV-0 l <br /> [Electronic InfOrM80011. 17 List 0 Map-Description: <br /> FILE A1313RESS EHD USE ONLY <br /> Street A Street Home city 0 unit I <br /> 1. 45D1 North Pershing Avenue Stockton <br /> 2. 0 Unit 2 <br /> 3. <br /> 4. 0 unit 3 <br /> 6. <br /> 7 <br /> 8. <br /> Unit 6 <br /> 10. Unit 6 <br /> Specific Data Range of Information Requested,From 1997 to Present <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0-6NDERGRount)TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> 0 OTHER CLEANUP SITE(MON-LOP) 0 FOOD FACILITY C1 WASTE TIRE <br /> 0 UNDVRGROUND TANK(MoN1TQmNG1RrMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 Tir;RFD PERMITTED FACILITY 11 MOTOLIHOTEL D Pumpr.R TRUCKIYARDI'CHEM TOILETS <br /> 0 TATTOOlBooy PIERCING 0 POOLISPA 0 LAND Ust APPLICATION SITES <br /> 0 MEDICAL WASTE.FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:0013M - 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)464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with I'lle addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <br /> days after receipt of application. The files will be held for 2 Maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3- A file that Is actively being worked on by the EHO staff may not be immediately available for review. A new application <br /> may he 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$98.00 deposit prior to review. <br /> EMD USE ONLY <br /> EHD AIG-116 10128l07 PUBLIC RECORDS RELEASE APP FORM <br />