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07/02/2007 10:16 FAX 0 0 <br />la 001/001 <br />DATF RECEIVED EHD LOG NUM6EH <br />f SII IU SAN-JOAQUINCOUNTY <br />ENVIRONMENTAL HEALTH DEPARTMTNT <br />600 E. Main Street, Stockton, CA 95202-3029 <br />! II.. ZGG7 Telephone: (209) 468-3420 Fax: (2119) q64-0138 Web: www +jgov.nrg/ c <br />0 7 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY: <br />ADDRESS:S I/ 6 (r 1 ry LP CC4_1P P2f vE 112'fiN CMC) COrWiW j gq-70 <br />d <br />PHONE (1): =116 SO) 17.61 PHONE (22))::41 6 '34-6 x-301 FACSIMILE: Yf 6 63 <br />TENTATIVE' APPOINTMENT DATE: Time: ANi <br />(Please allow 10 business days from date of application submetal - •Tontafrve only • must be confirmed) <br />D CHECK BOX TO EXPEDITE REQUEST <br />,-!i45_00 ;FE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT / <br />DATE 7-/-07 <br />Electronic Information: ❑ List ❑ Map -Description: <br />_ FILE ADDRESS <br />EHD USE ONLY <br />SueetS <br />�• <br />Street Nama_--- <br />EC . Hf10114t- WAY <br />Cny_ <br />Toot -B„) <br />ElUnit1 <br />5 Sm RW <br />• 6Sd <br />_- <br />S - S <br />LA-rwzo-p <br />IV Unit <br />3 IO(}i0 <br />GF}r11321D1rrr <br />%%12tIP <br />t1U.114 <br />5oi <br />Ph -T- <br />�. Er_ ppm�5T <br />SiackTuoJ <br />7HUQyJrp� (20. <br />{✓7Z7Clti'Or� <br />M� <br />237 <br />Cy /3f_t/p,. rJ <br />T2RGy <br />usr 5M 4W <br />8. <br />�V'\�CXp1��9 <br />❑ Unit 5 <br />-'-- I - .. . I ❑ units <br />From RLL to qLQ <br />U T-5 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />C iE (LOP) n HOUSING AIIA EMENT ❑ SOLID WASTE FACILITYIVEHICLF <br />IL 0 FOOD FACILITY n WASTE TIRE <br />VAL) ❑ DOG KENNEL ❑ DAIRY <br />17 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br />Ef TIERED PERMITTED FACU Lir ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br />O TATTOOIBODY PIERCING E3 POOLISPA r1 LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL ANI, SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 5:00 AM-5:OOPM - 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 appropriate <br />box(es). At least one file type 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 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 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 $95.00 deposit prior to review. <br />EHD USE ONLY <br />EHD <A-06 W1L2Uutl web <br />