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03/09/2010 15:43 925-416-0523 FEDEX OFFICE F155 PAGE 02 <br /> \i EHD LOG NUN BER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> \,C) \'D ENVIRONMENTAL HEALTH DEPARTMENT <br /> \, 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax; (209) 464-0138 Web:www.sJgov.org/e <br /> oy AS oaa PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KE L1/N BUSINESSIAGENCY: /' lrA/E-R aY-� , <br /> ADDRESS: 1.6 z-8 V. 4> KV 1122 _ CITY/STATEIZIP:P& Z�rA C.4 9yS6 „ <br /> PHONE(1): r `9LY3 PHONE(2): FACSIMILE: <br /> TENTATIVE"AP OINTMENT DATE: Time: <br /> (Please azo x 10 business days Iran date of application submittal-'rentative only-must be confirmed) <br /> ❑CHECK BOX TO EX-EOITE REQS�U7EE/ST-$115FEE(CA H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT != IY�°y DATE 3191/6 <br /> Electronic information:Y ❑List❑Map-Description; <br /> FILE ADDRESS EHD USE ONLY <br /> Sbuat aF street Name <br /> City �unit 1 <br /> 2 <br /> z. 3m <br /> 3. <br /> 4. unit M\ <br /> 5. J <br /> 6 unit a <br /> 7. <br /> g, u ❑I1nit s <br /> 9. <br /> 10. ❑IJnu e <br /> Specific Date Range of intormetion Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CIEAKUP SRE(LOP) ❑HuMm ABATenENT ❑SOLID WASTE FACILRYNEirCLE <br /> m OTHER CLEANUP SITE(NQN-U 1P) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONRQ ONGIREMOVAL)Ct— ❑DOC KENNEL ❑DAIRY <br /> ®HAWMUS WASTE GENMAT(R dam" ❑CHICKEN RANCH ❑WASTEWATER TRE4WENT PLANT <br /> TIERED PERNNTW FAMB15;< ❑MOTELIHOM ❑PWPEN TRUCIYAROiC VCAL-rOILEIS <br /> ❑TATTOOMM PIERCING ❑POOIJSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILrrY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 9;00 AM-5;OOPM EXCLUDING EIOLiDA'i Sj <br /> 1. List ue to ten addresses in the space above. Select the type(s)of flies from the list above by C`. K419 the 9pproprV,4b4, <br /> AI )cast one fit:type MMI T Im selected. Fax to 12091 464-01-M Of mail to-theaddt"r.indicoted_a_bove. Address <br /> .angel will not be acco)fed-for additional assistance with file addresses,contact the EM). Applirations received afb9r <br /> 3:00 pm will be process ad the next twsinass day. <br /> 2. The EHD will notify the r pplicarrt K any EHD files exist. An appointment for review will be confirmed appr®xIrnrteiy leu(10) <br /> days after receipt of apf I1ea"11. the files will be hold for S;ntdximum of five blrstness days for review. Appointmerds <br /> should be scheduled ac.ordingiy. <br /> 3. A file that is actively bel 19 worked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file Ls available. <br /> 4. Any file not returned in 1 he same condition as released will be reorganized by ETID staff at the expense of the applicant. <br /> Future file reviews by tti a same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assli tante,please contact Diane Martinez,at(209)4683425. <br /> ena USEONLY <br /> EXO qg$ a77r09 <br />