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p'e EHD LOG NUMBER <br /> [RII� V �� SAN JOAQUIN COUNTY <br /> ^ 2008 ENVIRONMENTAL HEALTH DEPARTMENT 'h7 <br /> NOV 11 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIR,0Nf0,EN7 HEATL Ipphone: (209) 468-3420 Fax:e(209)464-0138 Web: www.sjgov.org/ehd <br /> PER h4iiiiiSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: / BUSINESS/AGENCY: C- '-71 <br /> ADDRESS: �l(� - �S d kfle City/State(Zip <br /> PHONE( PHONE(2): / FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: I.,a 1 �S .✓f - Time:�C�Isb� <br /> (Please allow 10 business days from'date of plicatio submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU $105 FEE(C R CHECK,ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ^ZA 6 DATE D� <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city Unit 1 <br /> 1. � '_ u ES N <br /> 2. A it 6 rr or t( �OL) W r 6'I 011- { Unite \ <br /> 3. ddAo <br /> 4. (/C 1. "- .il SI NOfA/yP Unit 3 <br /> 5 NA Cp T <br /> 5. t <br /> Unita <br /> 6. <12 <br /> Q vlt� t\ lc�h,NO A/ter <br /> T' r v / I f N ❑ Units <br /> 8. 37�2 iynU 8[:_s) /VD to/ail' <br /> n <br /> 9. �j' N 0 rNG ❑ Unit <br /> 10. -- <br /> Specific Date Range of Information Requested:Frorm to . <br /> M ENVIRONMENTAL HEALTH EPARTMENT FILES p , <br /> yx UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 171 HOUSING ABATEMENT C] SOLID WASTE FACILrrYNEHICLE �O/�/'+ 2 V-77X OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE W" / I ./ <br /> K UNDERGROUND TANK(MONITORING/REMOVALV\ ❑ DOG KENNEL ❑ DAIRY <br /> IKHAZARDOUS WASTE GENERATOR/J, 0 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 0MOTELIHOTEL El PUMPER TRUCKIYARD/CHEM TOILETS <br /> •TATTOO/BODY PIERCING O POOLISPA 13 LAND USE APPLICATION SITES <br /> •MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - 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 fileaddresses,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 /> ( o L; c R c.0 <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />