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03/16/2007 15:10 FAX <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />MARI 6 2007 304 East Weber Avenue, 3' Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgiehd <br />ENVIRONMENV FILALI H <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />U002 <br />EHD LOG NUMBER <br />7-41 <br />BUSINESS/AGENCY: Waite. c a_ - KA IA I 3 /4- A55 cic:ic...4-0 APPLICANT: NJ kk Ke.rr - NtStn& tn-\ <br />ADDRESS: 3 4 10 iA)• 1.-cuPte,SA.c.1 '56,14-1-mk cA 9521 q <br />PHONE (2): (2...o 1) 234 -772_ 7 (4,), FAC--Sffkit': PHONE (1): (2...Cct) 23 ( <br />TENTATIVE* APPOINTMENT DATE: lime: <br />(Please allow 10 business days from date of application submittal - *Tentative oniy- List be confirmed) <br />7 0 CHECK BOX TO EXPEDITE RE T -.00 FEE (CA,, OR EC ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS / <br />Electronic Information: LI List Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # Street Name City unit 1 <br />1" 11315 t/J0-4--e,loc NI E i7 <br />2' ti 3 LH Wate-r I „ RI 4_ Unit 2 <br />3. (It-107 Weki-e.4- too g 4 E <br />/Unit 3 <br />4' IVA 13 Wed-e-i- too RJ i/l, <br />5- 1755 N Bry.S0.1 i Unit 4 <br />6.izq 0 5 n / <br />N 0 r- 'VIA 110 redo Ai <br />7. 0 4 oo 10e-vo terk Rg <br />z <br />1--i, cidd—z, v, Unit 5 <br /> <br /> IN Unit 6 <br /> <br />Specific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />SIGNATURE OF APPLICANT ' DATE <br />to <br />1 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NoN-LOP) <br />UNDERGROUND TANK (MoNrroaiNs/REmovAL) <br />HAZARDOUS WASTE GENERATOR <br />0 TIERED PERMITTED FACILITY <br />0 TATTOO/BODY PIERCING <br />0 MEDICAL WASTE FACILITY <br />0 HOUSING ABATEMENT <br />SOUD WASTE FACIUTYNEHICLE <br />0 FOOD FACILITY <br /> <br />0 WASTE TIRE <br />0 DOG KENNEL <br /> o DAIRY <br />0 CHICKEN RANCH <br /> <br />El WASTEWATER TREATMENT PLANT <br />MoTEUHarEt <br />0 PUMPER TrtucK/YArto/CHERA TOILETS <br />CI Foot/SPA <br />0 LAND USE APPLICATION SITES <br />0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Am-5:00Pm - EXCLUDING HOLIDAYS. <br />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 (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 />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 />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 />Any file not returned 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 $95.00 deposit prior to review. <br />END USE ONLY <br />EHD 48-06 9/13/2006