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Feb 10 2009 12: 58PM CRR 5104209170 p. 2 <br /> A � EH■LOG NUMBERIJ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I-;09 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjg e <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> n CU-1 2--, BUSINESWAGENCY: <br /> APPLICANT: _ <br /> ADDRESS: aLA CitylStatejzip (�– <br /> PHONE(1): PHONE(2): �FACSIM LE: –(?D-� <br /> t <br /> TENTATIVE"APPOINTMENT DATE: e Time: �J <br /> (Please allow 10 business days from date of app cation submittal-"Tentative only-must be cont3rmed) <br /> ❑ CHECK BOX TO EXPEDITE RE EST-$1D5 FEE(CASHOR_CHECK ONLY)-REQUEST PROCESSED IN 3 BUS E3s D YA S <br /> SIGNATURE OF APPLICANT DATE ( �fl-J1�„�,I <br /> Electronic Information: [] List ❑ Map-Description: <br /> FILE ADDRESS _ EHD USE ON__' <br /> Street# Street Name city <br /> Q ElUni!1 <br /> r. <br /> 2 ❑ Unit 2 <br /> 3. <br /> 4. --— -------_— Unit 3 \� <br /> 5. <br /> —– Unit 4 <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> --- – ---- -- --- ❑ units <br /> 10. <br /> Specific Date Range of Information Requested:From o l� ��- 7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOusING ADATEMENT ❑SOLID WASTE FACILITYNEHICL- <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILrY ❑WASTE TIRE <br /> DERGROUND TANK(MONITORINGIREMOVAQ ❑DOG KENNEL ❑ DAIRY <br /> RDOUS WASTE GENERATOR 11 CHICKEN RANCH 13 WASTEWATER TREATMENT PLAVT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑ PumPER TRUCKIYARD/CHEM T-ILETS <br /> ❑TATTOOJBODY PIERCING �[]',piOOLI 'PA rr--�� LA D USE A.P.P1LInGp/7}�oN�SI !,'(�J <br /> ED MEDICAL WASTE FACILITY �1JJTHER(PLEASE SPECIFY) T 'e lV 1 i (J] t LX ` ” <br /> WELL ANC-SEPTIC PERMIT RECORDS ARE A, eLE FOR REVIEW- MONDAY R-F IDAY 8:00 AM-6:0,DPM - EXCLUDING HOLT)_YS. <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 abe-e. 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 approxsTately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. App.intments <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 apps ration 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 EHO staff at the expense of t6.applicant <br /> Future file reviews by the same applicant may require a $105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4606 8/04/08 PUBLIC RECORDS REEASE APP FORM <br />