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09/23/2008 TUE 13- 32 FAX 0001/001 <br /> .0 iEJEC,If <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> elephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 'Syr--�Nlrsmmi 1� <br /> BUSINES51AGENCY: E ECD <br /> M <br /> ADDRESS: 300 L^Es I D V_ SIC.-Z-Z'0 City/Stie/zip Dfi(l b o1qviz- <br /> PHONE(l): PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: PLD�e SE—lUIPTime: <br /> (Please allow 10 business days from date of application submittal-*Tonfative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE?UEST-310?5/:EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9 1 <br /> Electronic Information: D List[I Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> P <br /> ocicToo Tjj 0ot I <br /> 2, ❑ unit <br /> 3. 100 <br /> 4. WO'Unit 3 <br /> 5. 'de <br /> 9runit 4 <br /> 7. <br /> 8. El Unit 5 <br /> 9. <br /> W'U.It 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �fi lCor <br /> VEDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT IlIlDLID WASTE FACILITY/VEHICLE <br /> Cl ER CLEANUP SITE(NON-LOP) M FOOD FACILITY 171 WASTE TIRE <br /> ERGROUND TANK(MoNrrORINGIREMOVA4)a 11 DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY M MOTEL/HOTEL M PUMPER TRUCKfYARDICHEM TOILETS <br /> 0 TATtoo/Sooy PIERCING 0 FOOLISPA 0 LANE)USE APPLICATION SITES <br /> 171 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 0:00 AM5:00pm -Excwomo HOLIDAY$. <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 address Indicated a.hLqKiz 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 /> days after receipt of application. The files will be hold 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 /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> 5, 6�tj, "2jn, <br /> 15 /)o <br /> END 48.06 $104100 PUBLIC RECORDS RELEASE APP FORM <br />