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JUPI 0 2008 Telephone <br />Er�����o�Yr,�EIv r ; 3ERLr <br />APPLICANT: <br />EHD LOC NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/Ld56 T <br />PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS: I)LIS I tar : Avt LA °Tril?;M <br />PHONE (1): Ilk 1460 O?,'Z$ PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time' <br />(Please allow ton business days from date of application submittal - *Tentative Only. must be confirmed) <br />CHECK DOX TO EXPEDITE RLQU T - $88 00 EE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE i7- T -QJ ? <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />d <br />Street Name <br />City <br />_ 0 Unit f <br />� UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />^Bursar <br />1 <br />_a 1 "k V(- <br />UAIr? -- <br />2 <br />b <br />C-e'si W , qk Aje, <br />eANod <br />Ino CpiSP `— oUnit2 <br />9- <br />`I 1 <br />�e+zc.Y rj <br />a <br />� <br />�1 <br />')Dc_ <br />Nodbino(0/1 <br />0 PUMPER TRUCKNARDICHEM TOILETS <br />O TATTOOIBODY PIERCING <br />Ly <br />0 LAND USE APPLICAnON SITES <br />0040 <br />1 <br />❑ OTHER (PLEASE SPECIFY) <br />Ito <br />5 5 e zP <br />L <br />G r <br />8. <br />o Unit s <br />9. <br />��- <br />0 Unit S <br />Specific Date Range of Information Requested: From L&M <br />to ' .rt1 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />j <br />� UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />T HOUsim ABATEMENT <br />O SOLID WASTE FACILITY/VENKLE <br />UAIr? -- <br />� OTHER CLEANUP SITE (NON -LOP) <br />O FOoo FAcH-r Y <br />C3� <br />WASTE TIRE <br />V (c�18110IF <br />D UNDERGROUND TANK (MONITOWNWREMOVAL) <br />❑ Doo KENNEL <br />❑ DAINY <br />HAZARDOUS WASTE GCNERAToRDC <br />❑ CHICKEN RANCH <br />0 WASTEWATER TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY <br />O MOTELIHOTEL <br />0 PUMPER TRUCKNARDICHEM TOILETS <br />O TATTOOIBODY PIERCING <br />O POOUSPA <br />0 LAND USE APPLICAnON SITES <br />13 MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILAF LE FOR REVIEW - MONDAY -FRIDAY 8:00 Am.5;00PM - EXCLUDING HOLIDAYS <br />1. last 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 12091 484-0138 or mall to tho above address. Address ranges will <br />not be accepted -for additional assistance with ills addresses, contact the EHD. Applications received after 3:00 pm will <br />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 ton <br />days after receipt of application. The files will be held for a maximum of Nve business days for review. Appointments <br />should he scheduled accordingly. <br />3. A file that Is actively being worked on by the EHD staff may not be Immediately available for review. A new appllcation <br />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 applicant. <br />Future file reviews by the same applicant may require a $98.00 deposit prior to review. <br />EHD tOSE ONLY <br />n �a <br />ENDO Glom? PUDLIC RE RDD RELEASE APP FORM <br />100/1002 <br />XVj 93:tit 8003/60/90 <br />