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TB'd 7d101 <br />DATE RECEIVED EMD LO <br />SAN JOAQUIN COUNTY <br />Go-)ECi�lVW, i"DD <br />ENVIRONMENTAL HEAI,Ti-i DEPARTMENT <br />304 East Wcbcr Avenue, 3"I Floor, Stockton, CA 95202-2708 <br />SEP 13 2007 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www_sjgov.org/ehd <br />FNV1HQ,WjF T , G I TH PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY: <br />ADDRESS:�kb1 <br />PHONE (t):'Lt�S1> PHONE (2): FACSIMILE: �1�(0'�-`y's3- <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from dato of application submittal - "Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDIT ST • 95.00 FEE (CAS R CHEC Y -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 1b�CS' ZQ� <br />UNIT DISTRIBUTION <br />0 Unit 1 ❑ Unit 2 nit 3 AKUn1t4 ❑ Unit S d Unit S ❑ Other (electronic/lists/maps) �Tl <br />[-12 j Street 4 <br />FILE A.DDRESS <br />Street Name City <br />EHD USE ONLY <br />i <br />I <br />- - -- <br />4. <br />6. <br />7. <br />8. <br />10. <br />Specific Date Range of Information Requested: From 1Cto Y � <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />R�LINDFRGROUND TANK (UST) CLEANUP SITE (LOP) M HOUSING ABATEMENT ❑ SOLID WASTE FACIUTYIVEHICLE <br />,❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY E: WASTE TIRE <br />0 UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />13 HAZARDOUS WASTE GENERATOR 171 CHICKEN RANCH G WASTEWATER TREATMENT PLANT <br />O TIERED PERMITTED FACILITY E] MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br />❑ TATTODIBODY PIERCING ❑ DOLISPA O LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE PACILITY THER (PLEASE SPECIFY)C� Cis- Tt� � ti't.� �R`Qb� 11-1 <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS- --J <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact <br />the EHD. Applications received after 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 <br />approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br />days for review. Appointments 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 <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br />applicant. utu a file reviews by the same applicant mayrequire a $95a $95.00 deposit rior to review. <br />EHE) 69-06 <br />8!1!06 <br />TBiTO'd 2,8b0 b82, 9T6 3_nIf1350�1 - NODdaa31 8T:0T L20E-2T-d3S <br />