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11/ZU/ZU0y 15:28 San Joaquin County -> 4640138 2 <br /> IR1� RlUlt)SI �D EHD LOG NUMBER <br /> u `-� SAN JOAQUIN COUNTY <br /> t J 0 2009 ENVIRONMENTAL HEALTH DEPARTMENTAll 40"M- 'I Z <br /> F Ar <br /> 600 East Main St.Stockton, CA 95202-3029 <br /> EN;i'R0'0V',,'EST 19EALTTflephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/e <br /> 1-1 LI: a �'v V I L PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:__D G RR lr- Rn wr BUSINESS/AGENCY: <br /> ADDRESS: _44-_N • 'SAN Tv 5zy rt;t 30 CITY/STATE/ZIP: S <br /> rnG o�! C•/a y 5 r o <br /> PHONE(1): (n2ok) 4 (o C,. �7o PHONE(2): FACSIMILE: Out) q44-'2s/_5 <br /> TENTATIVE*APPOINTMENT DATE: Dt.0 4- , Time:_/():c.:, <br /> (Please allow 10 business days from data of application submittal--TenfaUve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQI� ST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE NoV 19, .2o,y <br /> Electronic Information: 0 List 0 Map—Description: <br /> FILE ADDRESS EHO USE ONLYG <br /> Street# Street Name Ci yN/'� <br /> A PN ' 4] D Unit 1 <br /> 1. X705 COLIa1rR CLL{ <br /> N 11�V_ d -.t to•o S fuGK ronl Lty r t <br /> 2. 213.2 G. AP/pa.SA /=D• 173 0(o i� o-� <br /> 3 L N o+s •13o-1Lo D i <br /> 7 ' L". Hwy 011-066-4 t_or.Kr_Fot_'0 Unit <br /> 6. 3 N.CHC-e0961: LN 04 3,,1 .o'i Lool j,( ,•1]y ` <br /> 6. UI Y = =rto/4n! , < /_30 1 q L0p_1 ® 7 nit <br /> 7. <br /> 8. <br /> D Unit 6 <br /> 9. <br /> 10, <br /> D Unit 6 <br /> Specific Date Range of Information Requested: From to C U U.PCAl V <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE i <br /> ®UNDERGROUND TANK(MONITORINGiREMOvAL) 0 DOG KENNEL ❑DAIRY C(,..1 ii <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY <br /> ❑MOTEUHOTEL ❑PUMPER TRUCKIYAROiCHEMiCAL TOILETS <br /> TATTOO/BODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SiTES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies 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 mall 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 END files 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 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 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$116 deposit prior to review. <br /> 6. if you need further assistance,please contact Diane Martinez,at(209)468.3426. <br /> END USE ONLY <br /> -Q <br /> EHD 4b-06 - Rk,V r//ut.- r l <br /> /1 t� <br /> �} � ��e Y13 !27109 <br />