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UAI t KtI:tIVtU <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTII DEPARTMENT <br />304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ebd <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />351�v <br />APPLICANT. %d `t', I 2_ i^� BUSINESSIAG/ENCY: <br />ADDRESS: `/ i74"riQ.g7Y Ct+r. s ST! <br />PHONE (1): 6 P ONE (2): Sc`.. -.A FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />208 -?d2.0 <br />❑ CHECK BOX TO EXPEDITE REQUEST -19,3.00 FEE (CASH/OAR CH NL QUEST PROCESSED IN 3 BVS[NESS AYS <br />SIGNATURE OF APPLICANTDATE <br />In <br />Eformatilectronicon <br />13 List ❑ Map - Description <br />FILE ADDRESS <br />EHD USE ONLY <br />Street If Street Name <br />City <br />1' <br />G� <br />❑ Unit <br />2. <br />1 <br />3. <br />El Unit 2 <br />4. <br />5. <br />,e Unit 3 <br />6. <br />7. <br />;eUnit 4 <br />8. <br />9. <br />LL, <br />❑ Unit 5 <br />10. <br />JIB Unit 6 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />IIE <br />DERGROUNOTANK (UST)CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT �OUD WASTE FACILTIYNEHICLE <br />HER CLEANUPITE(NON-LO1313 FOOD FACILITY WASTE TIRE <br />DERGROUNDTANK(MONITORING/REMOVAL) 13DOG KENNEL ElDAIRY <br />OURMITTED FSWASTE GENERATOR❑ CHICKEN RANCH 13WASTEWATER TREATMENT PLANT <br />RED PEACILITY N F.F ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 6:00 AAIS:00PA1 - 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 <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />Indicated above. Address ranges will not be accepted — for additional assistance with file addresses, contact <br />the EHD. Applications received after 3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately ten (10) days after receipt of application. The files will be held fora maximum of five business <br />days for review. Appointments 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 <br />application 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 <br />applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />' <br />�J <br />EHD 48�C <br />10/31/2006 <br />5\�v <br />