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10/02/2008 10: 17 FAX a 001/001 <br /> DA ED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> v ENVIRONMENTAL. HEALTH DEPARTMENT <br /> OCT 2 2008 600 East Maln Street, Stockton, CA 95202-3029 v�2 <br /> Telephone; (209)468-3420 Fax: (209)464-0138 Web: www.s19ov.org/ehd <br /> ENVIRONMENT HEALTH <br /> PFRMIPSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �,q� 1 BUSINESSIAGENCY: <br /> idol Ull Cltyl8tata2lp IP O <br /> PHONE(1): "I PHONE(2)• KFACSIMILE: 33 <br /> TENTATIVE"APPOINTMENT DA Time. <br /> (Plee6e allow 10 business de fro date of apps tion submittal•'Tentative only-must colr0rmad) <br /> CHECK BOX TO EXPEDITER OU - 06 FEE CAS R ONLY)-REQUEST PROCESSED IN S BUSIN SF,S DAYS <br /> SIGNATURE OF APPLICANT DATE d 8 <br /> Electronic Information: ❑List ElMip—Descript on: <br /> FILE ADDRESS EHD USE ONLY <br /> straat;k Straet Name city <br /> i. ❑ <br /> pr 2. a Unin UST, PW V%/jOCO - Unit2 <br /> 3. 5P <br /> 4, oMlf IYUUW units <br /> 5, <br /> unk4 <br /> T• 1 Unit s <br /> fir- LV Y <br /> ,N LASE 9. � P_ UOT, ffvj, BES, NOLO <br /> unite <br /> 10. Q p� " V- 0 O s �! <br /> Speck Date Range of Information Requested:From Cl 110 to e <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 9 F��S FQf <br /> �(7 <br /> kNWD'=DTANK(UST)GLEANUPS[TE(LOP) 0HouslNaAsATEMENT �§ouoWASTEFACIUTYIVEMci_E X13UPSITE(NON-LOP) P F000 FACILITY TE TIRE <br /> /� O DOG KENNEL AIRY IDl(�RGROUND TANK(MONITORMGIREMOVAL)y -RDOUS WASTE GENERATOAC< 13 CHICKEN RANCH STEWATER TREATMENT PLANT <br /> (01�/ 0 TERED PERMITreo FACILITY 0 MOTEI/HOTEL PER TRUCKIYAROICHEm TOILETS <br /> TATToolSoDT PIERCING O PoDVSPA ND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 9:00 AM-6:00PM -ExcL=w HOLIDAYS. <br /> 7. List up to ten addresses In the space above. Select the type(a)of files from the list above by checking the appropriate <br /> box(es). At hast one file type MUST be selected. Fax to(209)464-0138 or mail to the aldross 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 flies 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 Tile 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$106 deposit prior to review. <br /> EHD USE ONLY <br /> 0 <br /> EHD 4e-06 6/04108 PUBLIC RECORDS RELEASE APP FORM <br />