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05/03/2010 14:57 4085597601 AEI SAN JOSE PAGE 01/01 C=V`'� DATE RECEIVED. EHD LOG NUMBS SAN JOAQUIN COUNTY P �,i M ¢ f, l ENVIRONMENTAL HEALTH DEPARTMENT FTViti � N 1�_; � i I1�n�- I 600 East Main St. Stockton, CA 95202-3029 FL N'li I' u`L_V",� lephone: (209) 4683420 Fax: (209) 464-0138 Web: www.sjgov.arg/ehd PUBLIC RECORDS RELEASE APPLICATION APPLICANT:_p O)T BUSINESSIAGENCY: ADDRESS: D (� s �j�� a CITYISTATE/ZIP: PHONE (1): l Z� "J/ PHONE (Z):(� () 0 FACSIMILE: TENTATIVE* APPOINTMENT DATE: Time: (Plea®e allow 1 D business days from date of application submittal - "Tentative only - must be confirmed) ❑ CHECK BOX TO EXPEDITE REQUEST - 7 FE (CASH p�R cHE K ONLY) - REQUEST PROCESSED IN 3 OUSINESS DAYS SIGNATURE OF APPLICANT 1T/11 N�' L DATE LJ — � — 10 Electronic Information: ❑ List ❑ Map - Description: FILE ADDRESS EHD USE ONLY ❑ Unit 1 , (UST) SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE THER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ Street N Street Name City (MONrrORINGIREMOVALY)( ❑ DOG KENNEL ❑ DAIRY WASTE GENERATOR Z5 _T4(j LVD, �1. ❑ �ATTOOISODY PIERCING POoUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ZOTHER (PLEASE SPECIFY) ol1, 1 V02,�yeJ�J�.p 3 2 34F2_41 Ea A uJlL =P box(es). At least one file type MUST be selected. Fax tg2OSi 4640138 or mall to the address indicated above Address � 0E-5, Unit 3 4. 3:00 pm will be processed the next business day. 5. days after receipt of application. The files will be held for a maximum of five business days for review. Appointments It 4 6, 3. A file that 19 actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 7. _*r, ❑ Unit 5 8. 9. ❑ Unit 6 10. I Specific Date Range of Information Requested: From 0 a f�.� to 4 ENVIRONMENTAL HEALTH DEPARTMENT FILES ONDERGROUND TANK CLEANUP �> J I , (UST) SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE THER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE INDERGROUND TANK Z� (MONrrORINGIREMOVALY)( ❑ DOG KENNEL ❑ DAIRY WASTE GENERATOR �AZARDOUS ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT IERED PERMITTED FACILiTYV ❑ MOTELIHOTEL ❑ PUMPER TRUCKINARD/CHEMICALTOILETS ❑ �ATTOOISODY PIERCING POoUSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ZOTHER (PLEASE SPECIFY) ol1, 1 V02,�yeJ�J�.p WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY S:DO AM-5;OOPM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax tg2OSi 4640138 or mall to the address indicated above Address ranges will not be accepted - for additional assistance with file addresses, contact the EHO, Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EMU files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that 19 actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $115 deposit prior to review. 5. If you need further assistance, please contact Diane Martinez, at (209) 468-3425. Fmn s Bf2T109