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Mar 28 09 12: 57p -JLS- Brandstad 1209 887-1804 <br /> -�- <br /> EHD LOG NUMBER <br /> I--I �rn <br /> 1 tL�1;._! „ GtuD I__! SAN JOAQUIN COUNTY ,/ <br /> 0] 3 I <br /> -3 <br /> ENVIRONMENTAL HEALTH DEPARTMENT `/.// <br /> WAR 2 600 East Main Street, Stockton,CA 95202-30295 ov.orgf <br /> C�Af2 `' 6 2C09 <br /> 1C; 1. Telephone: (209)468-3420 Fax: (209)464-0138 Web:wCW. I <br /> i�Vl�,r1(,,s��'ai_I;f t#EC( i S RELEASE APPLICATION �21 -j <br /> ?E f:'ii-' t'7P, Ir FS PUBLIC RECORD BUSINESSIAGENCY: <br /> APPLICANT: ••� 1"l (zipCilState <br /> ADDRESS: ng�m <br /> FACSIMILE: <br /> (2): V <br /> PHONE 01: PHONE <br /> Time:i— <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from data of application submittal-'rentauve only.-must be confirmed) <br /> 0 CHECK BOX TO EXPEDI £O EST $105 FEE,{CAS1 H OR CHFgK NLY)- QUEST PROCESSED IN 31BUSINESS DAYS`^ <br /> .1-.1 Pr.\I A"1 DATE _:” <br /> SIGNATURE OF APPLICANT� ._.v <br /> Electronic Info tion: ❑List❑Map-Description: <br /> FILE ADDRESS f EHD USE ONLY <br /> -- ----t'-- - <br /> Streets Street Name Cky_._,__-_ /� r Unit <br /> -_- - _,i`'�:,__ ❑ Unit 2 <br /> /1 ._...____ <br /> 3. Unit 3 <br /> U 5 �Unit4 <br /> 6. <br /> 7. —_ -- -__- _._. ❑ unit <br /> 9- ❑ unit <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �"l e <br /> L'�IJNOERGROUNO TANK(UST)CLEANUP SITE(LOP) O HOUSING ASATEMENT ❑SOLID WASTE FACILIWIVEHICLE ' I ( �NYA <br /> C3,cOTNER CLEANUP SITE(NON{OP) ❑FOOD FACILITY 13 WASTE TIRE IIY1i j' 3. <br /> la UNOERGROUNdTANK(MONITORIrVREMOVAL�, ❑DOG KENNEL ❑DAIRY ((��jj1f�� 1II111ee 11 = a <br /> �AZARDOUS WASTE GENERATOR OCMCKEN RANCH O WASTEWATER TREATMENT PUNT N �j��, I <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCKNARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELLANOSEPTIC PERMITRECORD5 ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAYS:oO 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48. 111v -- <br /> PUBLIC RECORDS RELEASE AAP FORM <br />