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�0'd -111101 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> AEF�E V E ID ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> APR 2 1 2009`elephone: (209)486-3420 Fax: (209)464-04313 Web.www.sjgov.arg d <br /> ENVIROWENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 A �Qr� ` l I1� BCr <br /> IUSINESSIAGt�7NCY: <br /> A tate <br /> ADDRESS, /'T Ci 1 + •. C•- i �.s�.t!i <br /> PHONE(1): �r 1 GJ�Y a�oq PHONE(2): Z44 +�Z,_'Z,.�r-� FACSIMILE: — -- <br /> TENTATIVE*APPOINTMENT DATE: AeoL, i�. � Time; 1,74 <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> cHi_CK SOX TO EXPEDITE REQUEST-$165 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS. <br /> SIGNATURE OF APPLICANT DATE" r_/. <br /> Electronic Information: ❑ List E]Map—Description: <br /> FILE ADDRESS _ _ EHD USE ONLY <br /> µStreet 0 Street Name city <br /> Unit 1 <br /> 2. p._. 04..•..,�[1A. .F { ❑ unit 2 <br /> 6. <br /> _•............•,__...,-,_-- U�14 <br /> 7. .....�YtL4IL� gS ❑ Unft6 <br /> 8. <br /> 9 ' <br /> ------- w_. —-- © unit(; <br /> 10. <br /> Specific Date Range of Information Requested:Fromto <br /> ENVIRONMENTAL HEALTH DEPARTMENT F1LE5 <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOu$ING ABATEMENT n SOLID WA5TE rACILITYNEHICLE <br /> TKER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> ;IZIAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY 0 MOTELIHOTEL ©PuMPER TRUCKIYARDICHr_m TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOL/SPA IM LAND USE APPLICATION StTES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY)— _ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AvA1LARLE FOR REvisw - MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDfNG HOL.IDA <br /> rS• <br /> 1. List up 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 to(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted--for additional assistance with fire addresses,contact the EHID, 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 appi•ox€mately ten(10) <br /> clays 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 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 returned in the same condition as released will be reorgani ed by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> ]~HID U$E ONLY <br /> EHD 48.06 81W08 PUBLIC RECORDS RELEASE AFP FORM <br /> FOIE0'd 66TO 998 SES i (T.A1d210cidODHI 03JNd 02:92 600E—TE—C1db <br />