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06/10/2008 13:35 FAX 559 256 8 ORS FRESNO 12001 <br /> DATE RECEIVED i! EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL0EastMain HEALTH DEPARTMENT Jo17 <br /> 6(')0 East Main Street, Stockton, CA 95202-3029 <br /> �elephone: Q09)468-3420 Fax: (209)464-0138 Web: wvvw.sjgov.Or <br /> ,+,, PU&LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ' i'Y�FF4V-- %r_a, `os BUSINESS/AGENCY: <br /> ADDRESS: -JO )"LTUe;t Q :k- 1)�A,t..� bJE.�i 19--0 '�.tz.SWI01,q- 93-7ZO <br /> PHONE(1): 5S,.N- f(D- lll(a DU t: PHONE(2): !;SN-X3(3- g87G FACSIMILE: SS�'2r4 /y78 <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow ten business days from date of application submittal-'Tentative only•must be confirmed) <br /> CHECK BOX TO EXPEDITE REQ JEST-$98.0 gy FEE(CA/SH�R.CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ..t—^ o V DATE 6 1101d <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name city 0 Unit 1 <br /> 1 , mlmaT? $Cackl•N <br /> 2. <br /> 0 Unit 2 <br /> moa /-(. in(1rzl R. Sfaok. eH NOd.I3e <br /> 3• oo 41 do\ z v1, ac 1�1 oN <br /> 4. 00 �A\'ELLS( VL S'(-dL(Li'oN • • • /nit 3' \\" <br /> _ 5- "o T_04.0(T'At_ \,/LlS iso 0/J <br /> 5• 00 WL`( v AuC, IM410-0l nits <br /> - - <br /> 7. aoo --- ALUoY af3�.k..... _ i-oc.IL a!-1 <br /> 8' O9 v✓(�C,�UY 't�u Cz S f Oa(Lt'aA( 0 Unit 5 <br /> ase 9RD <br /> 3505 Nam 0 I I ST fJE c /!o <br /> 1 0 Unit 6 <br /> 3515 • <br /> Specific Date Range of InfermatiorE Requested:From to II <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �IPy /uftt <br /> 4pM DERGROUND TANK(UST)CLEANUP SrrE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACIUTY1VEHICLE <br /> La OTHER CLEANUP SITE(NON-LOP) '„ ❑FOOD FACILITY ❑WASTE TRE O )'.•-' V/ <br /> IG <br /> @ �> DERGROUND TANK(MONITORING/REMOVAL)PL ElDOG KENNEL ❑DAIRY 7 <br /> UI-HAZARDOUS WASTE GENERATOR C' 171 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOmom,PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT R,�CORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 6:00 AM-5:00PM'- EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the;:pace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). Al least one file type MUST be selected. Fax to(209)464.0138 or mail to the above address. Address ranges will <br /> not be accepted-for additiona6ssistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> be processed the next busines4 day. <br /> 2. The EHD will notify the applicapA if any EHD files exist. An appointment for review will be confirmed approximately ten <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 the EHD staff may not be immediately available for review. A new application <br /> may be submitted when the fild'is available. <br /> 4. Any file not returned in the sante condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the samei:applieant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4846 10129107 PUBLIC RECORDS RELEASE APP FORM <br />