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PRE07mr-n <br /> 22-2009 10:46 From: To:12094640138 Pa9e:1/1 <br /> • <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ,JUN 'All 2 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)458-3420 Fax: (209)464-0136 Web:www.sjgov.org/ehd <br /> EPS dif,Ofd HEATH <br /> PE ; ./-3ERUirI PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT! BUSINESSIAGENCY: t�-r'r"Gi_C cx-) <br /> ADDRESS: I(Q �-o(57� �r 1 C YC }(cam/P- Cityi8tato/zip �C_A 0 uQt a <br /> PHONE(1): 9 H C1' (-D( D lam' 9 PHONE(2): FACSIMILE: <br /> TENTATIVE' APPOINTMENT DATE: (.p I Z S C)Ll Timc; is <br /> (Please allow 10 business days from date of application submittal- Tentative only-must be confirms ) tti <br /> L'CHECK 6OX TO EXPEDITE REQUEST-$106 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESSVA <br /> SIGNATURE OF APPLICANT `-f lf( 1 n 4!7j(' DATE Lp/ <br /> -_j A <br /> Electronic Information: ❑ LiSt❑Map Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. oz ,pE�,�Rrtld Pa l9� <br /> �� VIP- <br /> IP- <br /> Unit <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. <br /> --- :. Ll Unit 5 <br /> 8. <br /> ❑ Unit 6 <br /> 10, <br /> Specific Data mange of Information Requested:From _._ {_SLP _____._ _ to <br /> ..... . ... . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Lam-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE <br /> M"OTHQq CLEANUP SITE(NON-LOP) 0 FOOD FACILITY C]WASTE nRE 1 1 //p I 1 Q <br /> M'UNDERGROUNDTANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> M`AA7AROOUS WASTE GENERATOR V, Ea CHICKEN RANCH 0 WASTEWATER TRSATMQNT PANT U/ <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL Cl PUMPER TRUCK/YARD/Cpm f0ILETB <br /> a TATTOO/BODY PIERCING C7 POOL/SPA O LAND USE APPUCATIOIN',�, ^' <br /> O MEDICAL WASTE FACILITY Cl OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PGRMIT RECORDS ARE AVAILABLE FOR REview- MONoAY-FRIDAY 8:00 AM-5;00PM - F-XCLUDING HOUD ' <br /> 1. List up to ten addresses in the space above. Select the typo(s)of files from the list above by checking the appropr <br /> box(es). At least one file type MUST be.selected. Fax to(209)464-0138 or mail to the address indicated above. Addres <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 held for a maximum of five business days for review, Appointments <br /> should bo schodulod 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> q r -I Y X 0 <br /> s• Ai r S o <br /> EHD 48-08 8/04/08 PUBLIC RECORDS RELEASE=APP FORM <br />