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JUL-20-2010(TUE) 13: 51 5a� Engineering Group, Inc (FAX)4 <br /> 806435 P. 00 1/00 1 <br /> EHD LOG NUMBER <br /> [9, 71 -,���F� SAN JQACtUIN COUNTY <br /> �� L U D ENVIRONMENTAL HEALTH DEPARTMENT <br /> Ji.-I!_ 2, 0, 2010 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehdehd <br /> yT$! ACl'H <br /> p� PUBLIC RECORDS RELEASE APPLICATION <br /> r�na <br /> APPLICANT: BUSINESSIAGENCY: 'Urrv, Gn4rneefioi 4r0prN <br /> ADDRESS: 1/�srD /1'1,if;an 1�trC U(i✓C �5 ,�._l�9" CITY/STATEIZIP: rzhv i_ us �,� GA 4 .70 <br /> PHONE(4): Cd �Sf�y-�903 PHONE(2): (W)$'e0-ry rf- FACSIMILE: vo-6"� r <br /> TENTATIVE*APPOINTMENT©ATE: Time: <br /> (Please allow 10 business days from date of Application submittal.*Tonmrive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REOUE6 -$ 5 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE O /-O <br /> Electronic Information: ❑ List❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City all Unit 1 <br /> 1. (aG3Y foci ;4 Are <br /> 2• ���J aci ie YG O do ]. IJo c04e 0,,UnItaf <br /> / d L <br /> 4. 5't�3 �il-ic Ave,e, .�T®c �» P k o rl1t$' <br /> �i✓S, Aj c ZA n <br /> 6 tlf incrin Ccod/ MT ir2tnit4 <br /> 7. <br /> 8. Unit s <br /> 9. <br /> 10- Lj_ ME1 <br /> Unit 6 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT EJ SOLID WASTE FACILIT'NVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE V 11 rr <br /> UNDERGROUND TANK(MONITORaIGIRI:MOVAI) DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR �jl_ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 MpIItg thgmeas 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 EHO files exist. An appointment for review will be confirmed approximately tan(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 sten may not be Immediately avallable 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(809)4$8.342$. <br /> EHD Use ONLY <br /> EHD 44-06 $127ros <br />