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06/03/2008 09:51 FAX 53024316°' C112n( HILL 0002/002 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT -70 ' <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.o /e <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1,4,, q S k&K _BUSINESSIAGENCY' CH�r1 Hfl I j <br /> ADDRESS: Z.�i hirgl f:�OI^ - <br /> PHONE(1): - "7Z I' �"°�' PHONE(2): FACSIMILE: 532-339-?243 <br /> TENTATIVE"APPOINTMENT DATE: I ZLb$ Time: 120V <br /> (Please allow ten business days from date of application submittal-•Tentarivu only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE-(CASH OR CHECK ONLY)-REQUEST PROCESSFO IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT @IIeR,! DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHDUSE ONLY <br /> Street# Street Name City 163I Unit 1 <br /> tl 00r'%105, L- VS d� <br /> �I)T'P ' 2 <br /> '�2'I S. R rar4,e /10"W 10 W1wi IllIFNu <br /> �V S. F_ Do and f� <br /> ��(� 74—!A— S a, c�i a1 S Z 4&41) Unit4 <br /> -\ 3t 5 t �imralfc 6 S - 1)-til) oes ()A-d <br /> o(Zh UnItS <br /> 54 <br /> �b( Ave 110 b ��'� nit s <br /> Specific pate Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHIC E <br /> rT THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY WASTE TIRE 44 n <br /> NDERGROUND TANK(MONITORING/REMOVAL) C3 DOG KENNEL ❑DAIRY n <br /> iAZARDOUS WASTE GENERATOR 1:1 CHICKEN RANCH WASTEWATER TREATMENT 11PLANT` <br /> [,TIERED PERMITTED FACILITY MOTELIHOTEL ❑PUMPER TRVCKIYARD/CHEM TOIL <br /> TATZ001BODY PIERCING ❑JPOOLISPA �LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY u OTHER(PLEASE SPECIFY) 0,0'A "WL <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5.00PM -EXCLUDING HOLIDAYS. <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 /> -10f) I U,I /,r►c ( "\ FTS W <br /> EHD 40-06 10120/07 PUBLIC RECORDS RELEASE APP FORM <br />