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MAR -13-2007 15:03 From:WCE 6056445929 Tc 194640138 P.2/2 <br />ECEIVED w EHD LOG NUMBER <br />''�V/ <br />(� j SAN .rOAQT7TIY COUNTY <br />ENWRONWiNTAT, HEALTH DEPARTMENT <br />fr4k ¢ 304 East Weber Avenue, 31" Floor, Stockton, CA 95202-2708 <br />2007 Telephone: (209) 468-3420 Fax: (209) 464.0138 Web: www.sjgov.org/eh i <br />EhiV; 30itiivicNT HEALI H PUBLIC RECORDS RELEASE APPLICATION <br />PFRo!IT!rr-nvY..�.. <br />APPLICANT: <br />ADDRESS: I 'p 7'D Y,�t ij'tf•('fV f'tVGN1A� S(Al M UQ Vr,7`1T1AV_A F Ljq" '7 :75UF1 <br />PHONE (1 ): OOrJ iDralj(ePHONE (2): FACSIMILE: _9015 29 <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Pleaw allow 10 business days from date of application submittal --Tentative only. must be confirmed) <br />❑ CHECK BOX TO EXPEUTTE R VEST - $95.00 FEE <br />�(1CASSH, OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPUCANT ���/�i DATE '�X719)xi / 0-4— <br />Electronic Information: ❑ List ❑ Map —Description: <br />FILE ADDRESS <br />CRY <br />STtK�ro� <br />EHD USE ONLY — ❑ Unit 1 <br />��,� <br />Street 0 <br />Street Name <br />A�cN- 2ottT� <br />1• <br />�°lSS <br />2. <br />..... - <br />unit 2 <br />.1-7� <br />3. <br />J Unif 3 <br />4. <br />5. <br />Unit 4 <br />❑ Unit S <br />S. <br />7. <br />8. <br />—. <br />10. <br />.. <br />_ <br />❑ Unit 6 <br />...... <br />Specific Date Range of Information Requested: From �1. _ to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />LV pNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING A9ATEMemr D SOLID WAsTe FAGILITYIVEHICLE <br />�DTHERCLEANYPSmsfNoN-LOP) D FOOD FAciuw 17 WRITE TIRE <br />n=ERGROUND TANK(MONITORINOIREMOVAL) C3 BOO KENNEL EIpMRY <br />Is HAzAaDous WASTE GENERATOR ❑CHICKEN RANCH OrWASTEWATER TREATMENT PLANT <br />O TIER90 Pffmameo FACILITY D MOTELIHOTEL D PUMPER TRUCKIYAROICHEM TOILETS <br />O TATTOO/BOOT PIERCING 11 POOUSPA ❑ LAND USE APPLICATION SITES <br />D MEDICAL WASTE FACILITY DOWER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Review - MONDAY -FRIDAY 8,00 AM-S:00PM - EXCLUDING HOLIDAYS. <br />I. 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 ono filo type MUST be selected. Fax to 1209) 464-0738 or mall 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 END will notify the applicant if any EHD filen exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The files will be held Tor 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 EHO staff may not be immediately available for review, A now 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 />EHD USE ONLY <br />EIID rOuc wurnvp <br />9 <br />