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Jun 15 2009 2: 58PM C6 510jF9170 <br /> p. i <br /> DATE RECEIVED -HD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> vi, , <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 ��//� <br /> J;i I S r1 'O0Uephone: (209) 468-3420 Fax: (209)464-0138 Web: wwW.sjgov.* ( / <br /> ' PUBLIC RECORDS RELEASE APPLICATION 11 <br /> APP<j1�A}l'E' ,,.�.-- BUSINESS/AGENCY; c dd <br /> ADDRESS; X00 r-w'1i C5 Ll CityfState2lp �--�^ <br /> PHONE(1): lO�I [�TENTATIVE'J 'J�� PHONE(2): FACSI LE: PJ (Jrig�� <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> Pl <br /> ( ease allow 10 business days from date of application submittal- <br /> �Qft (�Q 1 pp Tentative only-must be canTirmeQ♦ <br /> r�CHECK BOX TO EXPEDITE REQUEST-6.106 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSEESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE OILY <br /> nl / StreetM Street Name city /� <br /> ( � D CQ l 6 ❑ Unit 1 <br /> 2. <br /> 3. <br /> 4. <:U:":11;3 <br /> 6 u XC <br /> 7. - <br /> 6 ❑ Unit 6 <br /> 9. - <br /> Unk6 <br /> 10. <br /> (� <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES G <br /> tTATroolBODY <br /> EROROUNO TANK(UST)CLEANUP SITE ❑ HOUSING ABATEMENT OLID WASTE FACILITYIVE(_CLE l��i l//j'�,.��}(✓ <br /> ER CLEANUP SITE(NON-LOP) 17 FOOD FACILTrY �ASTE TIRE Y.'.' L 4 . <br /> EROROUND TANK(MONITOMNOIREMOVAL) � ❑ DOG KENNEL AIRY fff ll..fff /� <br /> ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT LANT <br /> EOPERMTEO FA CIL ❑ MOTEL/HOTEL t7 P MPERTRUCKfYARD/CHE TOILETS <br /> PIERCING OPOOUSPA ~jq-�-^,^,D USE APPLICATION StES 6 <br /> MEDICAL WASTE FACIL QS, 13 OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY at00 AMS:OOPM - EXCLUDING H=IDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking thoappropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address indicated move 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 files 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 aliDlication may be <br /> submitted when the It le is available. <br /> 4. Any file not returned in the same condition as released wil I be reorganized by EHD staff at the expense oP—.he applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD48-06 (1104108 — <br /> PUBLIC RECORDS P:ELEASE APP FORM <br />