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Oct, 28. 2008 10:03AM GF�SIS ENGINEERING & REDEVELOP No, 0154 P. 1 <br /> DATE RECEIVED CHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464.0138 Web:www.sjgov. r hd <br /> PUBLIC RECORDS RELEASE APPLICATI/ /W/oz <br /> /l <br /> APPLICANT: +ice_ /��2�LCIp -��1��__BUSINESS/AGEN>CY: _l/EA/k.5/$_F /�)Ef�l Y FLOE✓/ZCo9,N6A <br /> ADDRESS: _, Sl Cilylstale/Zip --- f3 9' S'36(� _ <br /> PHONE(1): '�09Qr�_�d� PHONE(2): �4y) ).7—S71U ____FACSIMILE: LO.� q;J_ c/%O_ <br /> J <br /> TENTATIVE`APPOINTMENT DATE: 'VVI/kM5/,t /a/ ZOdB Time: 9W <br /> (Please allow 10 business days from dale of application submittal-'Tenfaflve only-must he confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-005 FEE(C45H OR CHE K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ —// DATE <br /> Electronic Information: [:] List EI-Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street k Street Name <br /> 1. ❑ Uniti <br /> a�4rN...._l/kaALm,J L00/ <br /> 2. <br /> Unl!2 <br /> 3. <br /> 4. "R3 <br /> 5. \/ <br /> 8. Unit � <br /> 7.... <br /> 8 �_ ❑ unit 5 <br /> 9. <br /> Units <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES Iff fAt-DW <br /> XUNDEROROUNDTANK(UST)CLEANUPSITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHIC <br /> .Xyyl.�'THER CLEANUP SITE(NON-LOP) OFDob FACILITY 0 ASTE TIRE <br /> r.CUNDERGROUNDTANK(MONITORING/REMOVAL) 13 DOG KENNEL AIRY11 r� <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATERTREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TR=WYARDICHEM TOILETS <br /> 13 TATTOO/BODY PIERCING ❑POOLISPA ❑LAND SE APPLICATION ITES Q�(J p-�( <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)Mt)A/Irn ( r I,✓ [. ,JN 175 y�-/�f�9-/J <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:0OPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0130 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 ten(10) <br /> days after receipt of application. The flies 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 available 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 6104108 PUBLIC RECORDS RELEASE APP FORM <br />