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09/10/2008 WED 12: 17 FAX 2099480806 0001/001 <br /> EHD LOG NUMBER <br /> - SAN JOAQUIN COUNTY <br /> 2008 ENVIRONMENTAL HEALTH DEPARTMENT 6C7 SiIiiiiiiiiiiiiiiiii"" <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> EIv`JI UI\(al1�.i`!i NEALT Qlep one: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> E'11:'11,M I "" RViGLPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: }._ Ly BUSINESS/AGENCY: Nom{ tVSl�tl�'� <br /> ADDRESS: C �f}If.�7� � j�,�; _(�Lt CitylState/zip , ,W—K75Q3 <br /> PHONE(1): PHONE(2): �3--�r�� FACSIMILE: �_ —'97p <br /> TENTATIVEAPPOINTMENT DATE: AS Time: <br /> (Please allove 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$1 5 FEE SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS AYS <br /> SIGNATURE OF APPLICANT �. DATE �Q Cig <br /> Electronic Information: ❑ List[ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> - - ----- - Jt't?�GKYai`.> it <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 3 <br /> -- <br /> 5. <br /> 6. -- — - Unit 4 <br /> $ }} Unit 5 4 <br /> 9. -- -- Unit 6 <br /> 10. j <br /> 40 <br /> f <br /> Specific Date Range of Infor ation Requested: From L L to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �k <br /> 13 <br /> UNDERGROUND TANK(UST)CLE NUP SITE(LOP) C]HOUSING ABATEMENT 13N <br /> SOLID WASTE FACILITYEHICLE �" <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORI G/REMOVAL)t", ❑DOG KENNEL ❑DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEM TOILETS j <br /> ❑TATTOO/BODY PIERCING w ❑POOLISPA /^1 171LAND USE APPLICATION SITES <br /> 1:1 MEDICAL WASTE FACILITY b/ OTHER(PLEASE SPECIFY) A 4)_ i <br /> WELL AND SEPTIC PE IMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS, <br /> 1. List up to ten addresses i the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file ype 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 processec 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 appli ation. The flies 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> 11-0 L, A 110 <br /> Q ` Go aji26j _ S' o4Ii <br /> i <br /> EHD 48.06 8104/08 PUBLIC RECORDS RELEASE APP FORM i <br /> I <br /> i <br /> 1 <br />