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03/16/2007 15:10 FAX 0 002 <br /> EHD LOG NUMBER <br /> T SI /I IDS SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 1 6 2007 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 n <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd L <br /> ENVIRoN10EI�j 17EACiH <br /> pr. %r IT./SERVICES PUBLIC RECORDS RELEASE APPLICATION t <br /> APPLICANT: IVI k ''1K1e.JL�-L)(+•SI'LG vy. BUSINESSIAGENCY: wr+ll�• -K,..IAI *A55o�i�}°'� <br /> ADDRESS: 31110 tt) ttwwl•Ler t. a 1`6t- F S6cle 6p, .-CA "15219 - <br /> PHONE(1): (zGg) 231{-77bZ PHONE(2): (2-09) 23q-7727 ( .x) FAC-SHl11i£: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow to business days from date of application submittal."Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REfl T• .00 F/EE(CAS OR VEZ ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT '���i /� - DATE 316/0'7 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# 1� I Street Name L f city ❑ Unitt <br /> IN a <br /> r4. <br /> INtc'+`e-r koc ❑ ppts JTD34q � � Ra Unit2 <br /> '11407 wlt-erlco Rd E L Unita <br /> W,+-� toe Pi <br /> . 1755 N BveaSo, Unit <br /> 6. 1905 Nerd Br4rQu/a <br /> 7. 1100 e,04-oin. lel Sac w ❑ units <br /> 8. - - - - - ----- - <br /> 9. ❑ Units <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILIYNEHICLE <br /> OTHER CLEANUP SrrE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONrTORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> C3 TIERED PERMITTED FACILrrY ❑ MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑ POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 9113=6 <br />