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08/12/2009 06:23 9252741103 ARCADIS #0504 P. 002/003 <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH EP <br /> 1 2 �Q4g ❑ ARTMENT 3 , <br /> A1}�i 600 East Main St. Stockton, GA 95202-2708 <br /> �jEALJWWephone: (209)468-3420 Fax:(209)464-C 138 Web: www.sjgov,orglehd <br /> t5 <br /> peM'0111"ES PUBLIC RECORDS RELEMSE APPLICATION 7.7 <br /> APPUCANT: Le1gh NearU _ SUS INESSIAGENCY: G�-D1S <br /> ADDRESS: 3 i NOr M tri°t� b ITYISTATEMP:_I Q]n u (,/ � � CA <br /> PHONE('I): /[��X65 I�� PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: S Z I-;�/�Lvq Time; /0-'C-16 AM <br /> (Please allow 10 business days from date of application sub naf-'Tentative only-must be confirms <br /> CHECK 6OX TO EXPEDITE REQUEST-$115.pp FEE GASH OR CHEC ONL -FT-QUEST PROCE=SSED IN 3F <br /> ( Y) $ <br /> SIGNATURE OF APPLICANT DATE- 64;7, <br /> Electronic Information: ❑ LiSt M Map—Inscription: MAo R <br /> jqQ <br /> FILE ADDRESS EFID USE ONLY <br /> Stmt A 3troat Name Cit <br /> ❑Unit I' . <br /> 1. 1 SIS W. Fr e' <br /> 2. . tpSE-H11~ ST'96 $TOG iA" aftit2 <br /> S- . D! rxfviv S M GIG r mJ V\ <br /> 4. 130 sty <br /> Srp c.� <br /> 7• ee c nJ <br /> �l El Unitsl <br /> 9. Smc&. Tk- rt c4 <br /> 10 N. Tose r r . <br /> rat 6 <br /> Specific Date Range of information Requested: From / O to �2�Q _ (A L <br /> EWRONMENTAL HEALTH DEP RTMENT HL.>_S <br /> LINPEROROUNo TAuK(UST)CLEANUP$ITE(LOP) �]iloWN0 AUATMWT $OuD WASTE FAGLITY WE <br /> OTHER CLEANUP STFE(NON-LDP) ❑FOOD FACILITY KWASTE TIRE <br /> UNDE RGRouND TANK(MQNrroRfNGIREMOvAL) ❑DOG = ❑DAIRY <br /> HAZARDOUS WASTE Gr NFRATOR ❑CFA J,WAST' WATER TREKFd ENT <br /> �TIEREDPERI RED FACILITY ❑MOT L �PUMPERTRUcKIYARDICHEmi <br /> []TATToofRwY RERcMO 0 P A �LAND Uw-:APPLICATION SnU <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPEC <br /> WELL ANI]SEPTIC PERMIT RECORDS ARE AYAILABL.E FOR REVIEW MON AY-FRIDAY 8:OO AM-5:ODPM(EXCLuDINa HOLIDAY$) <br /> 1_ List up to ten addresses in the space above. $elect the type(s)of file&from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or m it 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 EHD files exist. An appolintmi nt for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximurr 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 inarnat lately 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 releasol will be reorganized by EHD staff at the expettse of the applicant <br /> Future file reviews by the same applicant may require-a$115.00 deposit prior to review. <br /> EM USE ONLY <br /> ***If you need further assurance please contact Diane Marti E2 a (209)468-3425 directly. Thank Yoo ** <br /> EHU TC31f20Q9 <br />