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06/10/2008 TUE 12:19 FAX 775 824 9055 PIRR Q001/001 <br /> — . <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> (IEZOC8 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.sjgov. <br /> PER h4Fi `SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: �, �c��C r�fIt ] {U�I a95-),J Ifi 1y c�1 n n p() <br /> PHONE(1): ��s}"` ()t��-1"IC��S PHONE(2): ,j _ FACSIMILE: Oto(12 l@`'1- 3O"( 91 <br /> TENTATIVE"APPOINTMENT DATE;�{��{' � & U VVL, Ar Time: V�.qb lq_yI, <br /> (Please allow ten business days from date of application submittal-*Tentative only-must be conte-fir ed)� <br /> ❑ CHECK BOX TO EXPEDITE REQ UE $98.00 FEE SH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A44Ll4 / CQQ f_w� DATE <br /> Electronic Information: ❑List❑ Map -Description: <br /> FILE ADDRESS EHD USE_ONLY <br /> _ r Street# Street Name City - ❑Unit 1 <br /> & jd Cru r� - _( n .Caraa� :,-P <br /> 2 I I 17 Unit 2 <br /> 3. j 1 <br /> 4. i nit 3 <br /> nit 4 <br /> 7. <br /> �.._. _ V <br /> 8. <br /> Unit 5 <br /> 9. I <br /> .. -- <br /> 10. 1----• i_—-- -- ---� ----- _ <br /> Unit 6 <br /> Specific Date Range of Information Requested:From 'Y fffi�1R- i-SAMMA(to ffih I'MAI Su�IIM(� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3HOUSING ABATEMENT C3 SOLID WASTE FACILITYNEHICLE 1 '1y7�C <br /> ❑pTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O WASTE TIRE r -2 e <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL [3 DAIRY <br /> 1 t <br /> k.ZHAZARDOUS WASTE GENERATOR y4 ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING ❑POOLISPA O LAND USE APPLICATIO SJT S <br /> 13 MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) 7(jtO St (�i EGCj M. <br /> �Lf sl/t4SS ('IC({1 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:00PM -EXCLUDING AOLIDAYS. <br /> 1. 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 above address. Address ranges will <br /> not be accepted•for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <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 the EHD staff may not be immediately available for review. A new application <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 1012910 <br /> PUBLIC RECORDS RELEASE APP FORM <br />