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05/10/2008 09:54 <br />k DATER CEIVED <br />5(11 0 <br />91644E""93 MATT PAGE 01 <br />SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 - <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e d - J, <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: t I� ��'Qt—`�Y �1 BUSINESS/AGENCY: Df'L_�tJ i :'_ r1- 1C1, T. <br />ADDRESS: '21 -It C/ 14-(�- J -U %i l�% ! 5f1`k �•`t'"!Ei✓i�7 G� �J a'�X �LI J <br />PHONE (1):. q1 6 4f+L 39(-)3 PHONE (z): FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: S `2 q �?T Time: R^i <br />(Please allow ten business days from date of application submittal -'Tentative only - must ba confirmed)- <br />© CHECK BOX TO EXPEDITE REQUEST 00 FEE ASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE eUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS _ _ _ <br />EHD USE ONLY <br />-. <br />Street # <br />Street Name <br />City <br />0 Unit 1 <br />( .1410 0 6l� ,-IX <br />r32-. <br />( o <br />1W(00_) wfly :5- <br />1 16 <br />Yoo i iT� fiVEwuC <br />^44N�C.,4 <br />�''i��)It�sid+'t7 O Unit2 <br />4�- <br />. <br />151 --- <br />---CHIer 2 LJlgi <br />5 raCkTOr) <br />4./ <br />W-17feLdQ �� Y. <br />s r UC(C1(��i <br />t t �`� UO <br />Unit4 <br />5. <br />s• <br />%il <br />Kj / <br />7. <br />M <br />$. <br />k z'i%1 �► w� l <br />� � <br />ffqk065�, h�i � �1� ❑ Unit s <br />•9. <br />_' <br />10. <br />❑ Unit 6 <br />Specific Date Range of Information Requested: From /9 Q_ to 49 P2 5£rl i <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY 0 WASTE TIRE <br />.T!i1 UNDERGROUND TANK (MONITORWWREMOVAL) ❑ DOQ KENNEL ❑ DAIRY �I'j�fi� V% c 1 •Jt Vrn_/ <br />. HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT /� 17 {y <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS ;/ ) G Z /Up <br />❑ TATTOO/BODY PIERCING 0 POOUSPA ❑ LAND USE APPLICATION ITES k 1 <br />MEDICAL WASTE FACILITY © OTHER (PLEASE SPECIFY) ���/ ,"� � fCFLN ' 70 tj ( 7 PIL4A E <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS, <br />I. List up to ten addresses in the space above. Select the type(s) of files from the Ilst above by checking the appropriate <br />box(es). At 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 additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will <br />be processed the next business day. <br />2. The END will notify the applicant 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 FHD staff may not be Immediately available for review. A new application <br />may be 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 $98.00 deposit prior to review. <br />EHD USE ONLY <br />Gi _ W µ <br />EHO 49-05 10/29107 PUBLIC RECORDS RELEASE APA FORM <br />