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From:James Robinson Fax:+1(209)740-4303 TO:Public File Review Regl Fax: +1(209)464-0138 Page 1 of 1 8/14/200912:51 <br /> 1 EHD LOG NUMBER <br /> 0T (( 1EIv5j0 ti SAN .IOAQUINCOUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ' 1^ <br /> AUG 14 2009 600 East Main Street, Stockton, CA 95202-3029 �1 U (/ <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.ol�7 d <br /> ENVIRONh1ENi HEALTH _1 <br /> PERMIT/SFRVIPPq PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: James Robinson BUSINESS/AGENCY: JR Squared Consultme inn <br /> ADDRESS: PO BOX 1744 City/Statozip Valley Springs, CA 95252 _ <br /> PHONE(t): 209-772-3841 PHONEM: Cell - 209-6 2-5445 _FACSIMILE: 209-740-4303 <br /> TENTATIVE"APPOINTMENT DATE: All A 20, 2003 Pm <br /> Time: <br /> (Please allow 10 business days from date of application u �tt� *� a e only-must be confirmed) <br /> X)H CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ON L O ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT TE 08/14/09 <br /> Electronic Information: ❑ List ❑ Map —Description: <br /> FILE ADDRESS_ EHD USE ONLY <br /> street Street Name __ _ City <br /> 1• 1024 Mellon Avenue N I:mteca JV1 Al ❑ <br /> y, Manteca ! E9.NbtC( � �Qp U <br /> 3. 400 Jndustf'al Park Drive Manteca <br /> 4- 560 Indus -ial Park Drive Manteca W unit 3 <br /> 5• 551 Carne ie StManteca ' Jig <br /> Unit 4 <br /> 6- 555 Carne0c St Manteca ( r7/ltAD <br /> 7. <br /> $ Elunit 5 <br /> a. <br /> 10. ❑ unit 6 <br /> Specific Date Range of I rmation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES )Z hlPs kl- <br /> AIUNDERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE 1J_ <br /> IrIRv�IOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> sgUNDERGROUND TANK(MONITORINO/REMOVAL)O` ❑DOG KENNEL ❑DAIRY <br /> l�HAZARDOUS WASTE GENERATORJZ_ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT Y <br /> I�TIERED PERMITTED FACILITY Cl MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TArroo/BODY PIERCING 0 POOL/SPA ❑LAND USE APPLICATION SITES <br /> 0 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 /> t. List up to ten addresses in the space above. Select the types)of files 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 mail 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 appointment for review will be confirmed approximately ten(10) <br /> days 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 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 retumed 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 /> Ago A 5 yr I I <br /> � y <br /> r Sy Z 1 <br /> EHD 4846 &0.0 PUBLIC RECORDS RELEASE APP FORM <br />