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U5/13/ZUU8 14:48 PAX 415 882 9261 URS CORP-221 MAIN ST. 2001/001 <br /> IC � � W V a EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> AUG 13 2008 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONMENT HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ d <br /> PFP MTS ERV!CE- <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: M_A-kLN0h&'- (ol yo kA) S BUSINESS/AGENCY: LA ' <br /> ADDRE iS: y,Ac ' �f p �j <br /> ��" •p a. cAC ? CitylState/ZiP 'SA(<� f-R.(��•ypt.�dA�0a <br /> PHONE(1): G� �' �4' PHONE(2): <br /> TENTATIVE*APPOINTMENT DATE:_ Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDITE REQUEST_ 105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT^�--- DATE w <br /> CElectronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> �— Street# t Street Name City <br /> - � --... — Unit 1 <br /> YJ _ss� Lp/ nit 2 <br /> 2.3. 1 <br /> I _ <br /> 4. <br /> �nit_3 <br /> 5. _ <br /> 6. /00Unit <br /> /00Unit 4 wi <br /> 7. I __ l <br /> — — ❑ Unit 5 <br /> 8. ; <br /> -10- — - - — Unit 6 <br /> Specifi,.Date Range of Information Requested: From to •�- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES M„ r <br /> ; �INDEI;GROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT r}},,,SOLID WASTE FACILITYNEHICLE <br /> THE(;CLEANUP$ITE(NON-LOP) 13 FOOD FACILITY WASTE TIRE ' <br /> j UNDERGROUND TANK(MONITORING/REM OVAL)10t ❑DOG KENNEL /� AIRY <br /> „ HAZAf:DOUS WASTE GENERATOR ID CHICKEN RANCH ',R'WASTEWATER TREATMENT PLANT <br /> ��TIERED PERMITTED FACILITY ❑MOTEL/HOTEL , UMPER TRUCKIYARD/CHEM TOILETS <br /> C3 TATTCO/BODY PIERCING .&,POOL/SPA ",.rt tLAND USE APPLICATION SITES <br /> t '1YlEDICAL WASTE FACILITYX ❑OTHER(PLEASE SPECIFY) - <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 /> boxles). 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 /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> dayti 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 EHD staff may not be immediately available for review. A new application may be <br /> 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 /> FutL re file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> Kg _. <br /> EHD 48-C6 8/04/08 PUBLIC REG ORDS RELEASE APP FORM <br />