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05/03/2010 14:57 40855i7F01 AEI SAN JOSE PAGE 01/01 <br /> R)E <br /> DATE RECEIVED EHD LOG NUMBSFL <br /> 0 3 1(1iJ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _T, <br /> ENVIR)M"'�1"N 1 600 East Main St. Stockton, CA 95202-3029 <br /> i T: J1 I <br /> P I-L R M ,' 4' 11.� , Iephone: (209)4683420 Fax. (209)464-0138 Web., www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT:- Kah e%- H'I viol+ -- BUS IN ESSIAGENCY:-a( <br /> C- <br /> ADDRESS: 36 i 56D AVf 107 CITYISTATMOP, j 4<: )' 'qg?-L <br /> PHONE(1): 1 Zq 1 PHONE(2')- 40 51A: 6)0 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'T6nW1v6 only-must be confirmed) <br /> El CHECK BOX TO EXPEDITE REQUEST- LY)-REQUEST PROCESSED IN 3 PUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE LJ <br /> ElectrorTlc Information: El List 0 Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ <br /> Unit I <br /> � 1.5 S4Z5 T4(j D L,VD . <br /> UnIt2 <br /> el <br /> �0 <br /> M�w -5 <br /> 4, <br /> S. Unit 3 <br /> 6. <br /> — Unit 4 <br /> 7. <br /> 8. <br /> Ej units <br /> 9. <br /> Q unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL-H-6&DEPARTMENT FILES <br /> �MNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT 0 SOLID WASTE FACIL"IVEHICLE <br /> THER CLEANUP SITE(NoN-LOP) El FOOD FACILITY []WASTE TIRE <br /> NnERGRow TANK(MONrrORINGIREMOVAQX [:1 DOG KENNEL Q DAIRY <br /> )N�RAZARDOUS WASTE GENERATOR [:1 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT _r2l)0/10 <br /> IEREQ PERMITTED FACILITY Ll MOTELIHOTEL E:1 PUMPER TRUCKNARD/CNtMICALToiLETS <br /> 0 TATT0011300Y PIERCING M POOLISPA El LAND USE APPLICATION SITES <br /> Ej MEDICALWASTE FACKM SOTHER(PLEASE SPEWY) 4 1P2Vkjff+-ye <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:DDAm-5:00pmiEXCLUDING HOLIIDAYS) <br /> 1. List un 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 W(2091-464t0138 or 83iiii to the address indicated above., Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received atter <br /> 3M pm will be processed the next business day. <br /> 2. The END 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 flies will be hold for a maximum of five business days for review, Appointments <br /> should be scheduled accordingly. <br /> 3. A file that 19 actively being worked on by END 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 retumed In the same condition as released will be reorganized by END 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(209)468-3425. <br /> EHD USE ONLY <br /> :z 10 <br /> 11 Q-97 - I <br /> n 3- a <br /> C <br /> PHO 48.00 <br />