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LINT <br /> F)Mu ID SAN JOA UYN CO i} EHD LOG NUMBER <br /> 7Q Y <br /> E'NV[RONMENTAL HEALTH DEPARTMENT .. <br /> f JAN 0 4 2007 304 East Weber Avenue, 3'Floor, Stockton; CA 95202-2708 <br /> Ei�VIRa{Vi4'IEfVT HEALTH Telephone: (209)46$-3420 Fax: (209)464_0138 Web: www.sjgov.orglehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:—f/. c l �CF��u3�,�JD<e <br /> yl W 1 ' r 1 <br /> t3USINESSlAGENCY: �. O <br /> ADDRESS: 11,72 Ile- 1-3 a — <br /> PHONE(1): S2— 2 PHONE(2): 1 '�-7 U S t : <br /> . FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow IO business days Time: <br /> from date of application submittal-*Tentative only.must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE � <br /> FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 B SINESS DAYS. <br /> SIGNATURE OF APPLICANTDATE <br /> ' <br /> Electronic Infonnatio,n: ❑List E] Map-Description: <br /> FILE ADDRESS �'. EHD USE ONLY <br /> Street N Str <br /> eel Nam <br /> e City - <br /> ❑ Unit 1 <br /> 2' 2S� <br /> L4. <br /> 230 a_ ❑ Unit <br /> 2 <br /> Unita <br /> 6. K <br /> lialt�4 <br /> O <br /> 7. 1-&it5 ` <br /> 70: ❑ Unit a <br /> Specific Date Range of Information Requested:From to _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(t-OP) E3 HOUSING ABATEMENT E3 SOLID WASTE FACN.rikEHIcLE <br /> THER CLEANUP.SITE(Nom-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> - <br /> 12UNDERGROUND TANK(MONIYORINGJREmOVAL) ❑DOG KENNEL E5.DAIRY <br /> XHAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> E3 TIERED PERMITTED FACILITY O MOTELMOTEL [3DUMPER TRUCIUYARDICHEM TOILETS <br /> l TATTOOlBODY PIERCING E l POOLISPA E3 LAND USE-APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY E7 OTHER <br /> .(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(i)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464AI38 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 bo 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 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 /> Future file reviews by the same applicant may require a$95.00 deposit prior to review., <br /> I <br /> EHD USE ONLY <br /> I{ <br /> F <br />