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DMDDD SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 0 3 2008 600 East Main Street, Stockton, 38 Web: wVV. 7YO' <br /> Telephone; (209)468-3420 Fax: (2pg) 464-0138 Web: www.SjgOv.0 /e� <br /> ENVIRONMENT HEALTH (((((( <br /> pL=UERVICES PUBLIC RECORDS RELEASE APPLICA N <br /> APPLICANT: <br /> ADDRESS; <br /> 8USINESS/AGENCY; <br /> PHONE(1): GdS]raaCltyrstotamp 1od <br /> A24?09-3 ] 301 <br /> PHONE(2): <br /> TENTATIVE*APPOINTMENT DAT E; FACSIMILE: 709 (7 -4778 <br /> (Please alivW 10 business days from tlate of appl catlo submlMal••TentaKve On Tmomust 6e confjrRt®d)-� <br /> CHBCK BOX TO EXPEDITE REQUEST $106 FE ASH OR CHLCK ONLY)-REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT p <br /> DATE <br /> Electronic Informatlon: ❑ List❑Map—Descriptio . <br /> FILE ADDRESS <br /> _ Street• EHD USE ONLY <br /> _ Street Name City - <br /> .... fj Unit t �1 <br /> 4, 21qunita . <br /> .w: <br /> 6. <br /> Unit 4 <br /> 7, <br /> 8" ❑ Unit <br /> 9. <br /> 10, Y ❑ units <br /> Specific Date Range of Information Requested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE LOP C3 3 les <br /> OTHER CLEANUP SITE(NON-LOP) ( ) ❑MOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> 'UNDERGROUND TANK(MONITORINGIREMOVAL) FOG FACILITY C1 WASTE TIRE (/ <br /> ❑DOC KENNEL 0 DAIRY 7/ 3. <br /> AYaROOUS WASTE GENERATOR 0 CHICKEN RANCH p/[����> <br /> TIERED PERMITTED FACIUTY 0 WASTEWATER TREATMENT PLANT <br /> b TATTOO/BODY PIERCING ❑P O LISPA EL 0 PUMPER E APPLICATION SI M TOILETS <br /> 0 MEDICAL WASTE FACILITY 0 OTHER P EI LAND USE APPLICATION SITES <br /> 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 9:00 AM-6:00pM -E%ELUDING 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)464-0139 or..loll to the address lndlcated abev <br /> ranges will not be accepted.,for additional assistance with Nie addresses,contact the EHD. Applications received drafter <br /> 3:00 Pm will be processed the next business day, <br /> 2. The EHL)will notify the applicant If any EMD 111Rs 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 file is available. <br /> 4. Any fife not returned in the same condition a$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 /> EHD 48.08 8/00/08 <br /> PUBLIC RECORDS RELEASE APP FORM <br />