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DATE at 6.t23v LOOO 11 :03AM advanced Ge0E0vir011TIen(al N0. I83OEHDP'__�.+IUMBER <br /> L � SAN JOAQT7IN COUNTY ..i <br /> RE - L��LJ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> APR 2��8 Telephone: (209)468.3420 Fax: (209)464-0138 Web:www.sigov.org/chd <br /> Fns t;plU''T i HEALTH PUBLIC RECORDS RELEASE APPLICATION •••/// <br /> RG i1f 11 I C C C�'�I I�G f <br /> APPLICANT:��a ri 6t n"' Y/GInRAlz&k BUSINESSIAGENCY: my-'-(n(ee'f <br /> ADDRESS: 3 T S6taw r'C-t7 GTC <br /> PHONE(1): AP7—1X6, PHONE(2): W0f — f`QW 7 FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-7onfatt"only-must be confirmed) <br /> ,i CHECK BOX TO EXPEDITE REQU •$98.00 FE ( SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAY <br /> SIGNATURE OF APPLICANT DATE -Z: -� <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ON Y <br /> Unit t <br /> Street k Street Name City _ <br /> �?o S E 467- 1�(k 57'11� fwA- I U dl ;'td Sc, <br /> 'o SS E/7 srz4/eeIc ......_ 3Lk/_,, -- (LO -nd 5C_ �__. ❑ unit v <br /> X075 <br /> - � /Z�/ .SOu�'}��I) f3l- v/�t.�u.-f SF Jcl�I _. US�(0 7.> •t ff�•��I) I O S (J n5 it 3 �� <br /> VVV 6. $ 102 '. 0 v /10 <br /> 7. <br /> �� ...._ .._._ _____ ❑ <br /> Units <br /> 8. <br /> 9. Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUNn TANK(LIST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT Ait-90LID WASTE FACILITYNEHICLE ( I <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> f"NDERGROUND TANK(MONITORINGRREMOVAL) 11 DOG KENNEL ❑DAIRY X`v" <br /> 'I'"AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL M PUMPER TRUCK/YARD/CHEM TOILETS U`-\ <br /> TATTOO/BODY PIERCING I]POOUSPA ❑ LAND USE APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONOAY.FMDAY 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(ss). At least one file type MUST be selected. Fax to(209)464.0138 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 EHD will notify the applicant if any EHD flies 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 la avallable. <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 /> END U 06 WEB&9/2007 u <br />