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01/30/2008 14:15 707741?^71 <br /> *110 PAGE 01/01 <br /> DATE RECEIVED EHD LOG NUMBER <br /> _ SAN JOAQUIN COUNTY ��n <br /> U ENVIRONMENTAL HEALTH DEPARTMENT I T `li �7 � <br /> 600 East Manx Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.Sjgov.org/chd <br /> r(11F.L I T' PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSlAGENCY: r <br /> ADDRESS: I <br /> PHONE(1): - - pHDNE(2): FACSIMILE: 7W27- <br /> TENTATIVE'APPOINTMENT DATE; Time: I[� U <br /> (Please allow 10 businoss days from date of appll n submittal-•Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO QUEST-$$6 EE(C R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D Ys <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List 0 Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Srtrrere-t:9 Straet Name City <br /> 1 it / d AD nu cv1 ❑ UnN1 <br /> fi 2• of �� - t UST OL�: Raz <br /> 3. /l <br /> 1 4, Unit a <br /> 13nit4 , \ <br /> 6. <br /> C� 7. <br /> 0 ❑ Unlf 6 <br /> 8. <br /> �O <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK( <br /> (NON-LO <br /> US CLEANUP SITE(LOP) <br /> LOP) O HOUSING ABATEMENT OLID WASTE FACILITY'VEHICLE h` G <br /> OTHER CLEANUP SITE(NO LOP) ❑FOOD FACILITY WASTE TIRE <br /> NDERGROUNU TANK(MONITORIN✓IRRMOVAL)� 0DOD KENNEL 0DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH E3 WASTEWATER TREATMENTPLANT If Nom/ <br /> 0 TIERED PERMIT U FACILITY Cl MOTELIHOTEL ❑PUMPER TRUOKIYARoloHEM TOILETS <br /> ❑TATTOOISODY PIERCING M POOLISPA 13 LAND USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW-MONDAY-FRIDAY 8:00 AM•5:00PN - 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.(20914 4-0138 or mail to the address IOdlcated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applicatlonn received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD Tiles exist. An appointmentfor 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 ilia 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$88.00 deposit prior to review. <br /> EHD USE ONLY <br /> END aa.os wEB WhQor <br />